BMTCN - CHAPTER 6 WITH COMPLETE SOLUTIONS ALREADY GRADED A+

What are the types of cardiac diseases common post HSCT? What conditioning medications can cause these diseases? Cardiomyopathy, arrhythmias, congestive heart failure - high dose cytoxan and radiation causes this HTN/Dislipidemia: Immunosuppression meds HTN/Hyperkalemia: Cyclosporine HTN/Hyperlididemia and edema: Sirolimus How would you management cardiac disease in post-HSCT patients? Assess risk factors, follow up testing (EKG, ECHO, labs such as BNP, A1c, thyroid function), medications, weight loss, stress reduction What is the major cause of transplant-related mortality and morbidity? Infection-related complication. Depends on hx of infections, chemo regimen intensity, and type of transplant. What are the risk factors of the development of an infection post-transplant? -Hx of infection (CMV status, blood stream infection) -Type of transplant: Auto (regimen related) Allo (slow count recovery, GVHD) -Myeloablative regimen and immunosuppression drugs -HLA mismtached and CMV status What are the prevention and management of infection? -Vaccination (pneumococcus, Tdap, Influenza, meningococcus, Hep B, MMR (1 year post) -Surveillance (T cell counts, CMV screening) -Antibiotics Bactrim post transplant (6mo) -Avoid pets -Avoid sick people -Practice good hygeine -Safe sex practices -Follow travel guidelines What are other common post transplant complications? -Occular -Muscoskeletal -Psychological -Graft failure and rejection What is the major cause of occular damage post transplant? What are the clinical manifestations? Cause: GVHD Manifestations: Photophobia, conjuncitivits, ulceration, dryness, pain What is the treatment for GVHD of the eyes? -Cyclosporine eye drops -Eye shielding during TBI -Systemic immune suppression -Lubricate the eyes -Wearing eye protection What is avascular necrosis (AVN)? Painful condition that develops when blood supply to the bone is disrupted What are the risk factors of developing AVN? -GVHD -Old age -Acute leukemia -TBI -Steroid Therapy How do they diagnose AVN? MRI What is the treatment for AVN? -Rest -Pain medicine -Hip replacement What are the three skeletal complications for pediatric HSCT? -Osteochondroma (painless bony lesions on the central of peripheral skeleton) -AVN -Diminished bone marrow density How can skeletal complications affect a pediatric patient? Ability to perform well in school and interact with peers What puts post-transplant patients at risk for psychological complications post HSCT? -Pain -Multiple readmissions -Slow recovery -Lack of support system -Female gender -Poor coping skills -Previous psychological hx What are the psychiatric diseases commonly seen post transplant? -PTSD -Distress -Depression What are treatment options for the psychological changes after transplant? -Support groups -Antidepressants -Psychoeducational interventions (symptom control, therapies, education) -Relaxation techniques What is the difference between primary graft failure and secondary graft failure? Primary: lack of initial engraftment Secondary: Loss of donor cells after initial engraftment What are the causes of graft failure? -Immunosuppression -ABO incompability -Viral infections -Source of cells (higher in cord blood due to smaller cell volume in cord blood and less strict guidelines for HLA matching) -Use of T cell depeletion Rejection is caused by recipient immune response against donor immunohemtapoietic cells How can the medical team prevent graft failure? -More intensity conditioning (TBI) -Donor cell boost (consider T cell depletion due to the increased risk of GVHD with cell boost) -Donor lymphocyte infusion (DLI) When is DLI used? used in cases of decreasing donor T cell chimerism What are the side effects of DLI? GVHD and marrow aplasia What underlying disease causes prolonged neutropenia? Myelofibrosis What are the risk factors that lead to neutropenia and infection complications post transplant? -Recipient (old age, infection hx) -Conditioning regimen (Steroids, radiation, chemo) -Immunosuppressants (steroids prevent neutrophil activity) What are the manifestations of engraftment syndrome? -Fever 38.3 without identifiable infection source -Rash 25% of body surface without evidence of medication reaction -Pulmonary edema (Minor) -T billi 2mg -Increased serum creat -Weight gain -Encephalopathy What are the common drugs that cause drug induced thrombocytopenia? -Asprin -Busulfan -Carboplatin -Cytoxan -Cephlosporin -Cytarabine -Etoposide -Ganciclovir -Melphlan -NSAIDS -Penicillin -Thiotepa -Sulfa- -Bactrim -Valacyclovir -Vancomycin What can contribute to anemia in transplant patients? -GVHD -Cyclosporine -VOD -Altered mucosal barriers -ABO incomtability -Viral infection -Delayed or failed engraftment