BMTCN questions and answers graded A+2023/2024

BMTCN What type of transplants commonly have PTLD as a secondary malignancy? - correct answer Allo HSCT with T-cell depleted graft Therapies associated with therapy-related acute leukemia and MDS - correct answer alkylating agents (eg. Cytoxan, cisplatin, melphalan, busulfan, ifos) , radiation, topoisomerase II inhibitors (eg. doxorubicin, etoposide, mitoxantrone) Genetic predispositions that increase risk of primary and secondary cancers - correct answer neurofibromatosis type 1, Fanconi anemia Risk factors for PTLD - correct answer T-cell depleted graft, mismatched related or unrelated donor. Busulfan, ATG, mAbs, TBI patient w/ primary immunodeficiency, acute or extensive GVHD, EBV Risk factors for secondary solid tumors - correct answer younger age at HSCT, TBI, chronic GVHD, increasing time from transplant, infections, genetic predisposition, lifestyle factors Treatment options for PTLD - correct answer EBV-specific cytotoxic T cells, mAbs targeted to B cells (rituximab), combination chemotherapy Treatment options for secondary MDS/acute leukemia - correct answer conventional chemo or allo transplant. Poor outcomes. QOL domains - correct answer Physical, Functional, Psychological, Social, Spiritual/existential, Multiple interactions between domains Altered sexual health in male HSCT survivors - correct answer damage to the hypothalamic-pituitary-gonadal axis: elevated FSH, elevated LH, low testosterone levels; cavernosal arterial insufficiency causing ED Altered sexual health in female HSCT survivors - correct answer alkylating agents and radiation cause infertility and premature ovarian failure, elevated FSH and LG, low estradiol, menopausal symptoms Risk factors for vaginal alterations post transplant - correct answer POF (premature ovarian failure), TBI, chronic GVHD Risk factors for infertility - correct answer pre-HSCT antineoplastic therapy, exposure to alkylating agents, TBI or pelvic irradiation, older age Pregnancy risks in HSCT survivors - correct answer increased risk of preterm birth and low birth weight, cardiac decompensation during pregnancy 2/2 prior anthracycline exposure. Similar rate of spontaneous abortion to general population. Recommended vaccines - correct answer Pneumococcal, Diptheria-tetanus, Pertussis, Meningococcal, Inactivated polio Hep B, Recombinant Hep A, Influenza, Measles Mumps and Rubells, HPV When can HSCT survivors get vaccines? - correct answer inactive vaccines start at 6 months post HSCT, live vaccines start at 2 years post HSCT (in absence of ongoing immunosuppression and GVHD) Most common secondary malignancy in pediatric patients who received radiatios? - correct answer Nonsquamous call carcinoma Interventions/treatment for vaginal chronic GVHD - correct answer topical steroids, topical cyclosporine, vaginal dilation Prevention of vaginal chronic GVHD - correct answer patient education, topical estrogen, early initiation of HRT, vaginal dilation in absence of sexual activity, regular gyn exams Side effects of ovarian failure in prepubescent females - correct answer infertility, impaired sexual development, short stature