BMTCN EXAMINATION SET QUESTIONS AND
ANSWERS SURE A+
✔✔DLI (donor lymphocyte infusion) - ✔✔infusion from the original stem cell donor given
the setting of relapse disease after allogenic transplant. this allows the immune system
to fight the tumor by inducing a GVT effect
✔✔DLI disadvantage - ✔✔risk of inducing GVHD
toxicity can be significant if either severe GVHD or bone marrow toxicity from DLI
occurs. this treatment may be done without the use of further conditioning if the tumor
burden is not progressing rapidly.
pt with rapidly progressing tumors will need to receive chemotherapy prior to DLI to
debulk the tumor burden
✔✔research is looking at the use of DLI in - ✔✔post-allogeneic setting as prophylaxis in
pt with a high risk of relapse post-transplant
✔✔peripheral blood stem cells (PBSCs) - ✔✔the most use source of stem cells in both
autologous and allogeneic transplantation
✔✔the use of granulocyte-colony-stimulating factor (G-CSF) & plerixafor - ✔✔increases
the production of stem cells to mobilized out of the marrow space into the peripheral
circulation and is collected through apheresis
✔✔advantage of PBSC peripheral blood stem collection - ✔✔engraftment of neutrophils
and platelets is typically faster.
proc can be done in the outpatient setting
collection is well tolerated
early regimen related toxicity in the allogenic setting is decreased
hospitalization for the recipient is shorter because of earlier engraftment
increase immunologic function is evident compares to bone marrow
no anesthesia is necessary for donor
,✔✔disadvantage for PBSCs - ✔✔the procedure may require a central line for collection
collection may take several days
apheresis process may have many possible side effects (electrolyte imbalances,
thrombocytopenia)
sources contain more CD34+ cells than bone marrow ( related to GVHD in the
allogeneic setting)
✔✔advantage of bone marrow - ✔✔harvest can be completed in few hours
decrease risk of GVHD in allogeneic setting
✔✔disadvantage of bone marrow - ✔✔requires general or epidural anesthesia
risk for infection, bleeding and pain surgical site and bone damage
longer time of engraftment of cell lines
✔✔UCB umbilical cord cells - ✔✔rich source of stem cells
use for true HLA matc with potential recepient
✔✔UCB advantages - ✔✔ease of access to cord blood unit
short time from selection of cord blood unit until available for use
lower risk of GVHD
decreased risk for viral disease transmission
✔✔disadvantage of UCB - ✔✔increased risk for passage of genetic abnormalities
slower engraftment than BM or PBSC
delayed post transplant immune reconstitution
decrease GVT effect
increase risk of graft failure
impossible to get more donor cells if needed
cost
✔✔pt has undergone an allogeneic transplant using umbilical cord blood as a stem cell
source this makes him at high-risk post-transplant complications - ✔✔graft -failure
✔✔stem sources that decrease the incidence of GVHD - ✔✔umbilical cord blood and
bone marrow
✔✔potential candidates may complete assessment - ✔✔bone marrow and biopsy
lumbar puncture
ct and mri
bone scans and bone survey to assess skeletal involvement
tumor markers
pet scan
,✔✔HLA are - ✔✔glycoproteins that reside on the surface of cells located on
chromosome 6 and play a major role in the immune system ability to recognized self
versus nonself
✔✔hla action is to - ✔✔produce immune cells that destroy antigens
✔✔gvhd - ✔✔donor cells with different type of hla from recipient are infused the t
lymphocytes in donor graft may perceive the pt tissue as foreign this can mount an
immune response known GVHD
✔✔majority of Hematopoietic stem cell donors are - ✔✔caucasian
✔✔communicable diseases - ✔✔HIV
Hepatitis
syphilis
cytomegalovirus
human T lymphotropic virus
chagas disease (american trypanosomiasis)
west nile virus
✔✔rare cases of neupogen cause - ✔✔splenic rupture, MI and acute respiratory
distress syndrome
✔✔G-CSF - ✔✔a glycoprotein that stimulates the production of hematopoietic cells to
certain cells surface receptors
filgrastim (filgrastim-Neupogen) 10-32 mcg/kg per day
engraftment is 11 days, maybe given along with chemotherapy to mobilized progenitor
cells
✔✔GM-CSF - ✔✔a glycoprotein that causes partially committed progenitor cells to
divide and differentiate into neutrophils, monocytes.macrophages, and dendritic cells.
can also activate mature granulocytes and macrophages. maybe given along with
chemotherapy to mobilized progenitor cells
(sargramostim) 250 mcg stimulating progenitors stem cells
✔✔GM-CSF severe side effects - ✔✔supraventricular arrhythmias, immune
hypersensitivity reactions and dyspnea
✔✔pegylated G-CSF (pegfilgrastim) - ✔✔loner lasting form of G-CSF
stimulates production of hematopoietic cells by biding to certain cell surface receptors
6-12 mg/kg
adverse effect: splenic rupture, ARDS
✔✔recombinant human erythropoietin (EPO) (epoetin alpha) - ✔✔stimulate production
of red blood cells
, 3-4 daily concomitant doses of EPO 150-200 IU/kg along with G-CSF
black box warning: risk for MI, stroke and thromboembolism
✔✔Cyclophosphamide (Cytoxan) - ✔✔destroy cells that divided rapidly including WBC.
aster nadir a transient increase in circulating stem cells occurs. these cells can be a
harvest for the transplant to administer concurrently with G-CSF or GM-CSF to
mobilized stem cells
iv and orally 1.5-7 g/m2
hemorrhagic cystitis
✔✔chemokine antagonist (Plerixafor-mozobil) - ✔✔blocks interaction between the
chemokine receptor CXXR4 and stromal-derived factor-1 causing stem cells to be
released from the bone marrow into the circulating blood.
used with G-CSF to mobilized hematopoietic stem cells for transplant in pt with non-
hodgkin lymphoma and Multiple myeloma.
✔✔Plerixafor (Mozobil) - ✔✔treatment is started after pt has received GCSF for 4 days
dose 0.24 mg/kg 11 hours prior to apheresis stem cell collection and may be repeated
for up to 4 days
✔✔Cyclophosphamide and paclitaxel cause - ✔✔a reduction in the production of blood
cells which stimulates hematopoietic recovery.
combining with G-CSF or GM-CSF a technique known as chemomobilization improved
cd 34+
✔✔chemomobilization - ✔✔cyclophosphamide, paclitaxel, etoposide and cytarabine
✔✔chemokine antagonist - ✔✔chemokines are small proteins produce by both
hmatopoiwtic and nonhematopoietic cells that regulate cellular movement
✔✔leukapheresis or apheresis - ✔✔stem cell collection in which cells are harvest from
the peripheral blood after mobilization
✔✔hypocalcemia during apheresis - ✔✔sodium citrate use to prevent blood from
clotting in the apheresis machine binds to ionized calcium causing a drop in the serum
calcium
✔✔hypocalcemia - ✔✔fatigue, chills, tingling in the lips and extremities and dizziness
✔✔apheresis side effects - ✔✔hypovolemia, thrombocytopenia, chills and headaches
✔✔Cryopreservation - ✔✔reduce # if nature blood cells in the sample
protect the cells from ice crystal formation and dehydration during freezing by using a
cryoprotectant such as dimethyl sulfoxide
add plasma protein to the product to prevent cell injury
ANSWERS SURE A+
✔✔DLI (donor lymphocyte infusion) - ✔✔infusion from the original stem cell donor given
the setting of relapse disease after allogenic transplant. this allows the immune system
to fight the tumor by inducing a GVT effect
✔✔DLI disadvantage - ✔✔risk of inducing GVHD
toxicity can be significant if either severe GVHD or bone marrow toxicity from DLI
occurs. this treatment may be done without the use of further conditioning if the tumor
burden is not progressing rapidly.
pt with rapidly progressing tumors will need to receive chemotherapy prior to DLI to
debulk the tumor burden
✔✔research is looking at the use of DLI in - ✔✔post-allogeneic setting as prophylaxis in
pt with a high risk of relapse post-transplant
✔✔peripheral blood stem cells (PBSCs) - ✔✔the most use source of stem cells in both
autologous and allogeneic transplantation
✔✔the use of granulocyte-colony-stimulating factor (G-CSF) & plerixafor - ✔✔increases
the production of stem cells to mobilized out of the marrow space into the peripheral
circulation and is collected through apheresis
✔✔advantage of PBSC peripheral blood stem collection - ✔✔engraftment of neutrophils
and platelets is typically faster.
proc can be done in the outpatient setting
collection is well tolerated
early regimen related toxicity in the allogenic setting is decreased
hospitalization for the recipient is shorter because of earlier engraftment
increase immunologic function is evident compares to bone marrow
no anesthesia is necessary for donor
,✔✔disadvantage for PBSCs - ✔✔the procedure may require a central line for collection
collection may take several days
apheresis process may have many possible side effects (electrolyte imbalances,
thrombocytopenia)
sources contain more CD34+ cells than bone marrow ( related to GVHD in the
allogeneic setting)
✔✔advantage of bone marrow - ✔✔harvest can be completed in few hours
decrease risk of GVHD in allogeneic setting
✔✔disadvantage of bone marrow - ✔✔requires general or epidural anesthesia
risk for infection, bleeding and pain surgical site and bone damage
longer time of engraftment of cell lines
✔✔UCB umbilical cord cells - ✔✔rich source of stem cells
use for true HLA matc with potential recepient
✔✔UCB advantages - ✔✔ease of access to cord blood unit
short time from selection of cord blood unit until available for use
lower risk of GVHD
decreased risk for viral disease transmission
✔✔disadvantage of UCB - ✔✔increased risk for passage of genetic abnormalities
slower engraftment than BM or PBSC
delayed post transplant immune reconstitution
decrease GVT effect
increase risk of graft failure
impossible to get more donor cells if needed
cost
✔✔pt has undergone an allogeneic transplant using umbilical cord blood as a stem cell
source this makes him at high-risk post-transplant complications - ✔✔graft -failure
✔✔stem sources that decrease the incidence of GVHD - ✔✔umbilical cord blood and
bone marrow
✔✔potential candidates may complete assessment - ✔✔bone marrow and biopsy
lumbar puncture
ct and mri
bone scans and bone survey to assess skeletal involvement
tumor markers
pet scan
,✔✔HLA are - ✔✔glycoproteins that reside on the surface of cells located on
chromosome 6 and play a major role in the immune system ability to recognized self
versus nonself
✔✔hla action is to - ✔✔produce immune cells that destroy antigens
✔✔gvhd - ✔✔donor cells with different type of hla from recipient are infused the t
lymphocytes in donor graft may perceive the pt tissue as foreign this can mount an
immune response known GVHD
✔✔majority of Hematopoietic stem cell donors are - ✔✔caucasian
✔✔communicable diseases - ✔✔HIV
Hepatitis
syphilis
cytomegalovirus
human T lymphotropic virus
chagas disease (american trypanosomiasis)
west nile virus
✔✔rare cases of neupogen cause - ✔✔splenic rupture, MI and acute respiratory
distress syndrome
✔✔G-CSF - ✔✔a glycoprotein that stimulates the production of hematopoietic cells to
certain cells surface receptors
filgrastim (filgrastim-Neupogen) 10-32 mcg/kg per day
engraftment is 11 days, maybe given along with chemotherapy to mobilized progenitor
cells
✔✔GM-CSF - ✔✔a glycoprotein that causes partially committed progenitor cells to
divide and differentiate into neutrophils, monocytes.macrophages, and dendritic cells.
can also activate mature granulocytes and macrophages. maybe given along with
chemotherapy to mobilized progenitor cells
(sargramostim) 250 mcg stimulating progenitors stem cells
✔✔GM-CSF severe side effects - ✔✔supraventricular arrhythmias, immune
hypersensitivity reactions and dyspnea
✔✔pegylated G-CSF (pegfilgrastim) - ✔✔loner lasting form of G-CSF
stimulates production of hematopoietic cells by biding to certain cell surface receptors
6-12 mg/kg
adverse effect: splenic rupture, ARDS
✔✔recombinant human erythropoietin (EPO) (epoetin alpha) - ✔✔stimulate production
of red blood cells
, 3-4 daily concomitant doses of EPO 150-200 IU/kg along with G-CSF
black box warning: risk for MI, stroke and thromboembolism
✔✔Cyclophosphamide (Cytoxan) - ✔✔destroy cells that divided rapidly including WBC.
aster nadir a transient increase in circulating stem cells occurs. these cells can be a
harvest for the transplant to administer concurrently with G-CSF or GM-CSF to
mobilized stem cells
iv and orally 1.5-7 g/m2
hemorrhagic cystitis
✔✔chemokine antagonist (Plerixafor-mozobil) - ✔✔blocks interaction between the
chemokine receptor CXXR4 and stromal-derived factor-1 causing stem cells to be
released from the bone marrow into the circulating blood.
used with G-CSF to mobilized hematopoietic stem cells for transplant in pt with non-
hodgkin lymphoma and Multiple myeloma.
✔✔Plerixafor (Mozobil) - ✔✔treatment is started after pt has received GCSF for 4 days
dose 0.24 mg/kg 11 hours prior to apheresis stem cell collection and may be repeated
for up to 4 days
✔✔Cyclophosphamide and paclitaxel cause - ✔✔a reduction in the production of blood
cells which stimulates hematopoietic recovery.
combining with G-CSF or GM-CSF a technique known as chemomobilization improved
cd 34+
✔✔chemomobilization - ✔✔cyclophosphamide, paclitaxel, etoposide and cytarabine
✔✔chemokine antagonist - ✔✔chemokines are small proteins produce by both
hmatopoiwtic and nonhematopoietic cells that regulate cellular movement
✔✔leukapheresis or apheresis - ✔✔stem cell collection in which cells are harvest from
the peripheral blood after mobilization
✔✔hypocalcemia during apheresis - ✔✔sodium citrate use to prevent blood from
clotting in the apheresis machine binds to ionized calcium causing a drop in the serum
calcium
✔✔hypocalcemia - ✔✔fatigue, chills, tingling in the lips and extremities and dizziness
✔✔apheresis side effects - ✔✔hypovolemia, thrombocytopenia, chills and headaches
✔✔Cryopreservation - ✔✔reduce # if nature blood cells in the sample
protect the cells from ice crystal formation and dehydration during freezing by using a
cryoprotectant such as dimethyl sulfoxide
add plasma protein to the product to prevent cell injury
