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BMTCN REVIEW CHAPTER 2-TYPES OF TRANSPLANTS AND SOURCES OF STEM CELLS QUESTIONS AND ANSWERS
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BMTCN REVIEW CHAPTER 2-TYPES OF TRANSPLANTS AND SOURCES OF STEM CELLS QUESTIONS AND ANSWERS
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BMTCN PRACTICE QUESTIONS WITHCOMPLETE SOLUTIONS
The administration of Epstein-Barr virus (EBV) cytotoxic T-lymphocytes has been found to be a
feasible therapeutic option in which EBV mediated-disease process?
a) Lymphoproliferative disease
b) Neuroblastoma
c) Nasopharyngeal rhabdomyosarcoma
d) Acute lymphocytic leukemia - answer A) Lymphoproliferative disease
Post-Transplant Lymphoproliferative Disorder PTLD is an aggressive, rare, and potentially fatal
proliferation of lymphoid cells of donor origin, usually occurring within the first four months
after allogeneic HSCT. PTLD is caused by the opportunistic expansion of Epstein-Barr virus (EBV)-
transformed donor B cells in a host with suppressed T-cell function
Donor leukocyte infusion is an appropriate treatment option for a patient who has relapsed post
allogeneic transplant with:
a) acute lymphocytic leukemia.
b) severe aplastic anemia.
c) chronic myelogenous leukemia.
d) acute lymphoblastic lymphoma. - answer C) chronic myelogenous leukemia
DLI has shown promising results for patients with CML in the chronic phase, with remission
rates of 70%- 80%. Unfortunately, this approach is less effective in patients with CML in blast
crisis or patients with MM, myelodysplasias, lymphomas, and acute leukemias
The success of DLI for the treatment of post-transplant relapse of chronic myeloid leukemia has
led researchers to explore the role of combining T-cell depletion with a preplanned course of DLI
post-transplant
,It has been demonstrated clinically that graft-versus-tumor responses occur with DLI in 60%-
80% of patients with chronic myeloid leukemia and to a lesser extent with acute myeloid
leukemia, chronic lymphocytic leukemia, multiple myeloma, non-Hodgkin lymphoma, and renal
cell carcinomas
Which of the following is most important prognostic element for a patient being treated for
pulmonary aspergillosis post-transplant?
a) Granulocyte recovery
b) Therapeutic serum fluconazole levels.
c) Serum IgG levels maintained greater than 400
d) Total number of CD34 positive cells in the donor's stem cells - answer A) Granulocyte
recovery
The most conventional way to monitor immediate hematopoietic recovery is through
granulocyte recovery. Granulocyte recovery is more rapid with blood versus bone marrow
autografts, regardless of whether mobilization is achieved with chemotherapy or with
hematopoietic growth factors
Patients who are most at risk for fungal infections are those who are neutropenic, are on
prolonged immunosuppression, or have chronic GVHD
Risk factors for an HSCT patient to develop aspergillosis include prolonged granulocytopenia,
the presence of GVHD, prolonged immunosuppression, human leukocyte antigen (HLA)
mismatch, construction near the hospital or a windy external environment, certain foods and
plants, and high-dose corticosteroid therapy
The Foundation for the Accreditation of Cellular Therapy requires notification of positive
microbial culture results on cellular therapy products to the:
a) recipient
,b) donor
c) Food and Drug Administration.
d) American Association of Blood Banks - answer A) Recipient
The goal of this evaluation is to protect the safety of the donor and the recipient. The potential
transmission of communicable diseases from the donor to recipient is a serious concern.
Therefore, laboratory testing includes complete blood count, electrolytes, and renal, hepatic,
and endocrine testing. Infectious disease testing includes hepatitis B, hepatitis C, HIV,
cytomegalovirus, herpes simplex virus, syphilis, and human T-lymphotropic virus, as well as
other infectious disease testing the transplant center deems appropriate. The donor also will
have blood and Rh typing, HLA testing, and pregnancy testing if applicable. A thorough physical
examination and medical history, including travel, immunization, and transfusion histories, will
be obtained
The potential transmission of communicable diseases from the donor to recipient is a serious
concern. Therefore, laboratory testing includes complete blood count, electrolytes, and renal,
hepatic, and endocrine testing. In
A patient is undergoing peripheral blood stem cell mobilization for an autologous transplant and
starts to experience fever, fatigue and bone pain. This is most likely due to:
a) a bacterial infection.
b) growth factors.
c) cytokine storm.
d) bone marrow hypoplasia. - answer B) growth factors
The most common side effects associated with growth factors used for mobilization include
bone pain, fever, and malaise
Daily nursing assessments should include a discussion of symptoms and an evaluation of the
patient's temperature, pulse, respirations, blood pressure, and weight. Patients may be
instructed to take acetaminophen for bone pain or headache. Occasionally, patients will request
a stronger pain reliever, such as acetaminophen with codeine. Other side effects should be
, assessed and treated symptomatically. More serious side effects (e.g., pleural or pericardial
effusions) may necessitate stopping the growth factors
What is the best initial step in determining the evidence available to support a current nursing
intervention?
a) Conduct a research study comparing two different processes to see which is better
b) Ask fellow nurses on the unit what their current practice is
c) Review current literature regarding the intervention, identify gaps or inconsistencies in
nursing practice
d) Evidence is not necessary to guide nursing practice - answer C) Review current literature
regarding the intervention, identify gaps or inconsistencies in nursing practice.
Managers should support introduction of new nursing interventions based on valid research
findings and encourage staff endeavors to implement new research findings when possible.
Clinical staff should be encouraged to review current journals for new, relevant research
findings. Staff should also be encouraged to question current nursing practices and look for gaps
where there is a lack of research-based practice (Haberman, 2007). Identifying gaps in the
literature and inconsistencies in HSCT practices is an important first step in designing evidence-
based projects that can be used to standardize practice and link best practices to improved
patient outcomes (Bevans et al., 2009).
Microangiopathic hemolytic anemia can be a complication from which immunosuppressive
therapy?
a) Tocilizumab
b) Antithymocyte globulin (ATG)
c) Cyclosporine
d) Alemtuzumab - answer C) Cyclosporine
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