BMTCN PAPER ACTUAL QUESTIONS AND ANSWERS
SURE A+
✔✔Syngeneic transplant - ✔✔Identical twin source. No need for immunosuppression.
No graft-versus-tumor effect
✔✔Matched sibling/related transplant - ✔✔HLA-identical relative. No potential stem cell
contamination. Continued access to cells. Only 25% of population has a sibling match.
Risk of GVHD.
✔✔Mismatched related transplant - ✔✔HLA-nonidentical relative. No potential stem cell
contamination. Increased number of potential donors. Increased risk of GVHD.
Increased risk of graft failure d/t HLA disparity
✔✔Matched unrelated transplant - ✔✔HLA-identical unrelated donor. No potential stem
cell contamination. Increased risk of GVHD. Limited number of non-caucasian donors.
Waiting period to identify donor.
✔✔Mismatched unrelated transplant - ✔✔HLA-nonidentical donor. No potential stem
cell contamination. Increased risk of GVHD. High treatment-related mortality.
✔✔Umbilical cord blood transplant - ✔✔Easy access to cell source. Limited number of
cells. Delayed time to engraftment, causing increased infection rates
✔✔Goal of therapy for Nonmalignant disease - ✔✔Cell line replacement (e.g., chronic
granulomatous disease, sickle-cell, aplastic anemia)
✔✔Goal of therapy for Malignant disease - ✔✔tumor ablation
✔✔Graft vs tumor effect - ✔✔promoted by withdrawal of immunosuppressant therapy,
promoted by DLI, decreased in absence of acute GVHD, associated with higher rates of
cancer relapse.
, ✔✔Autologous transplant pros and cons - ✔✔Pro: easily available source of stem cells,
decreased risk of side effects, early engraftment, low risk of GVHD
Con: contamination of stem cells by undetectable disease cells, no change of
immunologic effect of GVT to assist with control of relapse
✔✔haploidentical transplant - ✔✔half-matched related
✔✔Allogeneic transplant pros and cons - ✔✔Pro: disease-free stem cell source,
potential for GVT effect
Con: increased risk of side effects r/t polypharmacy (i.e. immunosuppressants), GVHD,
lifestyle changes r/t ongoing risks of side effects
✔✔DLI - ✔✔infusion of lymphocytes from original donor in setting of relapsed disease
after allo transplant. Induces GVT effect. Increased risk of inducing GVHD
✔✔Peripheral blood stem cell advantages - ✔✔faster engraftment, can be done outpt,
collection is well tolerated, decreased early regimen-related toxicity in allos, shorter
hospitalization, increased immunologic function compared to bone marrow, no
anethesia necessary for donor
✔✔Peripheral blood stem cell disadvantages - ✔✔may require central line for collection,
collection may take several days, lots of potential side effects from apheresis, contains
more CD34+ cells than bone marrow (related to GVHD in allos), increased risk of
chronic GVHD in allos.
✔✔bone marrow stem cell advantages - ✔✔harvesting complete in a few hours,
generally well tolerated and it outpt procedure, decreased risk of GVHD in allos
✔✔bone marrow stem cell disadvantages - ✔✔requires anethesia, surgical risks
(infections, bleeding, pain, bone damage), longer time to engraftment
✔✔UCB stem cell advantages - ✔✔ease of access to cord blood units, short time until
available for use, simple collection process w/ no harm to infant or mother, lower risk of
GVHD, decreased risk of viral disease transmission
✔✔UCB stem cell disadvantages - ✔✔increased risk of passage for genetic
abnormalities, limited use d/t number of stem cells in unit, delayed post-transplant
immune reconstitution, decreased GVT effect, increased risk of graft failure, impossible
to get more donor cells if needed, cost $$
✔✔G-CSF (filgrastim) - ✔✔glycoprotein that stimulates production of hematopoietic
cells by binding to certain cell surface receptors. Administered via daily SQ injections
SURE A+
✔✔Syngeneic transplant - ✔✔Identical twin source. No need for immunosuppression.
No graft-versus-tumor effect
✔✔Matched sibling/related transplant - ✔✔HLA-identical relative. No potential stem cell
contamination. Continued access to cells. Only 25% of population has a sibling match.
Risk of GVHD.
✔✔Mismatched related transplant - ✔✔HLA-nonidentical relative. No potential stem cell
contamination. Increased number of potential donors. Increased risk of GVHD.
Increased risk of graft failure d/t HLA disparity
✔✔Matched unrelated transplant - ✔✔HLA-identical unrelated donor. No potential stem
cell contamination. Increased risk of GVHD. Limited number of non-caucasian donors.
Waiting period to identify donor.
✔✔Mismatched unrelated transplant - ✔✔HLA-nonidentical donor. No potential stem
cell contamination. Increased risk of GVHD. High treatment-related mortality.
✔✔Umbilical cord blood transplant - ✔✔Easy access to cell source. Limited number of
cells. Delayed time to engraftment, causing increased infection rates
✔✔Goal of therapy for Nonmalignant disease - ✔✔Cell line replacement (e.g., chronic
granulomatous disease, sickle-cell, aplastic anemia)
✔✔Goal of therapy for Malignant disease - ✔✔tumor ablation
✔✔Graft vs tumor effect - ✔✔promoted by withdrawal of immunosuppressant therapy,
promoted by DLI, decreased in absence of acute GVHD, associated with higher rates of
cancer relapse.
, ✔✔Autologous transplant pros and cons - ✔✔Pro: easily available source of stem cells,
decreased risk of side effects, early engraftment, low risk of GVHD
Con: contamination of stem cells by undetectable disease cells, no change of
immunologic effect of GVT to assist with control of relapse
✔✔haploidentical transplant - ✔✔half-matched related
✔✔Allogeneic transplant pros and cons - ✔✔Pro: disease-free stem cell source,
potential for GVT effect
Con: increased risk of side effects r/t polypharmacy (i.e. immunosuppressants), GVHD,
lifestyle changes r/t ongoing risks of side effects
✔✔DLI - ✔✔infusion of lymphocytes from original donor in setting of relapsed disease
after allo transplant. Induces GVT effect. Increased risk of inducing GVHD
✔✔Peripheral blood stem cell advantages - ✔✔faster engraftment, can be done outpt,
collection is well tolerated, decreased early regimen-related toxicity in allos, shorter
hospitalization, increased immunologic function compared to bone marrow, no
anethesia necessary for donor
✔✔Peripheral blood stem cell disadvantages - ✔✔may require central line for collection,
collection may take several days, lots of potential side effects from apheresis, contains
more CD34+ cells than bone marrow (related to GVHD in allos), increased risk of
chronic GVHD in allos.
✔✔bone marrow stem cell advantages - ✔✔harvesting complete in a few hours,
generally well tolerated and it outpt procedure, decreased risk of GVHD in allos
✔✔bone marrow stem cell disadvantages - ✔✔requires anethesia, surgical risks
(infections, bleeding, pain, bone damage), longer time to engraftment
✔✔UCB stem cell advantages - ✔✔ease of access to cord blood units, short time until
available for use, simple collection process w/ no harm to infant or mother, lower risk of
GVHD, decreased risk of viral disease transmission
✔✔UCB stem cell disadvantages - ✔✔increased risk of passage for genetic
abnormalities, limited use d/t number of stem cells in unit, delayed post-transplant
immune reconstitution, decreased GVT effect, increased risk of graft failure, impossible
to get more donor cells if needed, cost $$
✔✔G-CSF (filgrastim) - ✔✔glycoprotein that stimulates production of hematopoietic
cells by binding to certain cell surface receptors. Administered via daily SQ injections
