BMT CERTIFICATION COURSE FULL SOLUTION PACK ACTUAL QUESTIONS AND ANSWERS WITH COMPLETE SOLUTION

BMT CERTIFICATION COURSE FULL SOLUTION PACK ACTUAL QUESTIONS AND ANSWERS WITH COMPLETE SOLUTION What does Red Bone marrow do Ans- Produces Hematopoietic Stem cells that create RBC, plt, and WBC found in long and flat bones Think: Red like red blood cells What does Yellow Bone Marrow do? Ans- Both Yellow marrow and fat cells produce stromal stem cells that produce fat, cartilage and bone Think yellow like fat Where are hematopoietic cells produced> Ans- in long bones during childhood and axial skeleton in adulthood What do Myeloid Progenitor cells mature into? Ans- Megakaryocytes (produce plts) erythrocytes --> RBC Mast Cells --> macrophages, myeloid dendritic cell Myeloblasts --.> WBC compoents What do Lymphoid Progenitor cells mature into? Ans- Small lymphocytes which differentiate into B-cells, T-cells and NK cells What organs are involved in the immune system? Ans- Bone Marrow Thymus (forms T-cells) Lymph Nodes Spleen (filter WBC, plts and other substances) Innate Immunity Ans- uses phagocytes that release inflammatory mediators and NK cells Acquired Immunity Ans- Response of either B-cells or T-cells Advantages of Syngenic (identical twin) Transplant Ans- No need for immunosupression Disadvantage to Syngentic Transplant Ans- No graft vs tumor effect Advantage to matched sibling/related transplant Ans- No potential stem cell contamination and access to cells Disadvantage to matched sibling/related transplant Ans- Only 25% of population has a sibling match Risk of GVHD Advantage of mismatched sibling/related transplant Ans- No potential stem cell contamination and access to cells Increased number of potential donor Disadvantage of mismatched sibling/related transplant Ans- Increased risk of GVHD Increased risk of graft failure d/t HLA disparity Advantage of unrelated donor Ans- No Potential stem cell contamination disadvantage of unrelated donor Ans- increased risk of GVHD Limited numbers of non-caucasian donors waiting period to identify donor Advantage of mismatched unrelated Donor Ans- No Potential stem cell contamination DisAdvantage of mismatched unrelated Donor Ans- Increased risk of GVHD High treatment related mortality Advantages of Umbilical cord blood transplant Ans- Easy access to cell source disadvantage of Umbilical cord blood transplant Ans- Limited number of cells Delayed time to engraftment increased infection risk Graft vs tumor effect Ans- Promoted by withdrawls of immunosuppressant therapy promoted by Donor Lymphocyte infusions Decreased in the absence of aGVHD Associated with high rates of cancer relaps post transplant lymphoproliferative disease is most often assiciated with what infection Ans- EBV while explaining the goals of SCT to a patient with AML, what does the nurse emphasze the transplant will do? Ans- produce a graft vs leukemia effect what is the max amount of DMSO that can be safely administered in 24h Ans- 1ml/kg what med is used in conjution with extracorporeal photophoresis Ans- Methoxsalen (8-methoxypsoralen is used eith ECP) an 8 year old pt who recieved a HSCT develops gradw 2 aGVHD skin rash.. what can the nurse anticipate for inital treatment Ans- Topical steroid cream as it should be used as first line therapy for gradw 1 and 2 skin gvhd which of the following is a non-HLA barrier for transplant research? a) lrg numbers of transplant pts available at each facility b) allele matching of donors to recipients c) heterogenity of RF d) FACT accreditation Ans- C which statement by the nurwse would indicate further teaching about transplant recipients is required? "important criterial used to evaluate a pt for HSCT include" a) support resources available to the patient b) current disease status c) age of caregiver d) baseline organ fx Ans- C grapefruit juice should be avoided when taking which med and why? Ans- Tacro .. it can increase the levels prior to starting treatment for engraftment syndrome what is the priority nursing action? a) obtain order for IV fluids b)ensure the infectious disease workup is complete c)place the patient in protective isolation for 14 days d) d/c GCSF Ans- B which of the following is a characteristic of stromal cells? Ans- Stromal cells are the primary location of hematopoiesis two hours after HSCT infusion a patient calls the nurse to report red urine. What is the most likely cause? A) breakdown of RBC in the product B) low PLT count C) hemorrhagic cystitis D) meds given prior to transplant Ans- A following an allo transplant, a patient arrives at clinic reporting weakness and fatigue that has worsened over the past week. Which nursing intervention would be the most appropriate? A) get an order to trasnfuse a unit of PRBC B) suggest the patient take long naps during the day C) encourage the patient to incorporate regular aerobic and resistance exercises D) request a refferal to skilled nursing facility Ans- C The caregiver of a patient at a clinic visit reports witnessing unusual behaviour, sleep problems and sadness. The nurse believes the patient may be exhibiting signs of A) PTSD B) BPD C) Posterior reversible encephalopathy syndrome D) Tacro Toxicity Ans- A a 45 year old female with AML arrives for her pre-transplant eval. The pts twin sister offers to donate but the MD opts to use a donor from the antional marrow donor program because: A) cost of immunosuppression meds is high B) the MD prefers to use the National Marrow Donor Program C) syngenic transplants increase the risk of tumor relapse D) the patients sister is also identified as her caregiver Ans- C .. due to no graft vs tumor effect the cluster of differentiation system is used to ... A) measure immune function B) crossmatch for blood product transfusion C) classify cell surface proteins on leukocytes D) identify different types of cytokines Ans- C the impact of stress on social function following transplant is greatest between... A) child survivor and siblings B) child survivor and parent C) survivor and extended family members D) survivor and spouse Ans- D premature ovarian failure after SCT is related to which of the following A) dx relapse B) Tx with alkylating agents C) Prescribed immunosuppresive meds D) GVHD Ans- B Which of the following is a disadvantact to the use of UCB?? Ans- Increased risk of graft failure common solid tumor diseases treated with Auto's Ans- Neuroblastoma Sarcoma Germ Cell Tumors Brain Tumors Breast Cancer Ovarian Cancer Melanoma Lung CA Common Hematologic Malignancies treated with Autos Ans- Hodgkins disease NHL MM Common Hematologic Malignancies treated with allos Ans- AML ALL CML MDS NHL? Juvenile Myelomonocytic Leuk hematologic non-malignant disease treated with allos Ans- SAA Fanconi Anelia Thalassemia Diamon-Blackfan Anemia Chediak-Higashi Syndrome Chronic Granulomatous Disease Congenital Neutropenia Common Immunodeficiencies treated with Allos Ans- Severe Combined immunodeficiency disease Wiskott-Aldrich Syndrome Functional T-cell deficiency Common genetic diseases treated with allos Ans- Adrenoleukodystrophy Metachromatic leukodystrophy hurler syndrome Hunter Disease Gaucher Syndrome Miscellaneous diseases treated with allos Ans- osteoporosis langerhans cell histiocytosis glycogen storage disease what is the goal of therapy for malignant disease Ans- tumor ablation what is the goal of therapy for nonmalignant disease Ans- cell line replacement (eg AA, sickle-cell dx,chronic granulomas) Graft vs. tumor efect Ans- Promoted by withdrawl of immunosuppressant therapy promoted by DLI Decreased in the absence of aGVHD Associated with higher rates of CA relapse Immune Reconstitution Ans- Dependant on patients hematologic response to preperative regimen Dependent on the rate of engraftment Dependent on survival and longevity of mature lymphocytes present at the time of transplant Delayed in patients with Chronic GVHD May take months to years Advantages of PBSC Ans- Engraftment of neuts and plts typically faster can be done in outpatient setting collection is well tolerated early regimen related toxicity in allo setting is decreased hospital stay decreased d/t faster engraftment an increased immunologic function is evident comapred to BM no anesthesia needed for donor Disadvantage of PBSC Ans- May require central line for collection May take several days to obtain adequate number of cells apheresis has many possible SE Source contains more CD34+ cells than BM (related to GVHD in allo setting) What is DLI Ans- infusion of lymphocytes from the original stem cell donor given in the setting of relapsed dx in allo setting. It attemps to use the immune system to fight the tumor by inducing GVT effect risk of DLI in allo setting Ans- risk of inducing GVHD Advantages of Bone Marrow transplant Ans- harvest can be completed in a few hours gnerally well tolerated and is an outpatient proceedure decreased risk of GVHD in allo setting Disadvantages of Bone Marrow Transplant Ans- Requires general or epideral anesthesia standard surgical risk of infection, bleeding and pain at site and bone damage Longer time to engraftment of cell lines Advantage of UCB Ans- ease of access to cord blood units short time from selection of cord blood unit until available for use simple collection process - no harm to mom or bb lower risk of GVHD Decrease risk of viral disease transmission disadvantaces of UCB Ans- Increase risk for passage of genetic abnormalities limited use b/c of the number of stem cells in any given unit slower engraftment of BM or PSCT Delayed post transplant immune reconsitiution Decreased GVT effect Increased Risk of graft failure impossible to get more donor cells if needed cost Patients require an EF of what before getting a transplant? Ans- 50% (ideally) what are HLA's? Ans- human leukocyte antigens - glycoproteins that reside on the suface of cells (located on chromosome 6) what do HLA's do Ans- Produce immune cells that destroy antigens What makes an optimal domor Ans- young male with heavier weight in the case of female ... young and heavy and no prior pregnancies how long prior to collection of stem cells should infectious disease testing be done? Ans- 30 days prior to collection what is the success of a sct measured by? Ans- CD34 cells obtained what are the main classes of drugs used to mobalize stem cells into the peripheral blood? Ans- Growth Factors Chemotherapy (cyclophos) and Chemokine antagonists (plerixafor) GCSF Ans- Stimulates production of hematopoietic cells by binding to certain cell receptors How many injections of GCSF are needed before stem cell collection? Ans- 4-5 days Common side effects of GCSF Ans- bone pain, HA, fatigue, muscle aches, N+V, stomach pain what are common chmo agens used to mobalization of stem celss Ans- cyclophos etoposide cytarabine paclitaxel how does chemo work in mobalizing stem cells Ans- causes a reduction in the production of blood cells, which stimulates hematopoietic recovery Plerixafor is used for mobalization of stem cells in what patients? Ans- NHL and MM when should plerixafor be given prior to mobalization? Ans- 11 hours before first apheresis procedure common side effects of plerixafor? Ans- Leukocytosis, thrombocytopenia, nausea, redness at injection sitem dizziness, diarrhea and fatigue what are some common symptoms of leukopheresis and why? Ans- S+S associated with hypocalcemia due to sodium citrate to prevent blood from clotting fatigue chills tingling in the lips and extremeties and dizziness other symptoms include: hypovolemia thrombocytopenia headaches what do we administer to patients before leukopheresis to prevent hypocalcemia Ans- oral calcium supplement and encourage pts to increase intake of calcium rich foods FACT requires is to change the amount of blood processed in apheresis for children. What is the typical amount that can be processed for pediatric patients? Ans- 200-250ml/kg when was FACT founded? Ans- 1996 Bone Marrow Transplants still happen today.. who are they typically used for? Ans- People who do not require graft vs. tumor effect (ie AA, sickle cell anemia) and pediatric donors how does chemokine antagonists (plerixafor) work in mobalizing stem cells? Ans- blocks the interaction between the chemokine receptor XCR4 and stromal derived factor 1, causing stem cells to be released from the bone marrow into the circulating blood. how does a RIC conditioning differ from myeloblative? Ans- doses are ~30% less RIC does not seek to eradicate tumor cells but to achieve immunosuppression to allow donors immune system to engraft explain how T cells play a contriuting role in engraftment Ans- the more mature present, the less likely graft failure will occur melphelan is the primary conditioning regiem for which diseases? Ans- MM and Amyloidosis what is the primary conditioning regiem for relapsed or refractory germ cell tumors? Ans- Carboplatin, ifosfamide and etoposide (or w/o ifosfamide) What are some conditioning regims for lymphomas and AML Ans- BEAM; TBI, cyclophos, and etoposide; thiotepa, bu and mel; cyclophos, carmustine and etoposide; bu+cy conditioning regimen for AA Ans- Cyclophos and ATG (+/- TBI) Nonmyeloblatic RIC regimes Ans- TBI + Flu; Flu+Cy; BU, FLU *can be used for all dx What myeloblatic regimes are used for pts with leukemia, MDS or lymphoma requiring an Allo Ans- TBI and etop; cy+tbi; FLU+BU dosing for myeloblative TBI Ans- between 12-15Gy over 8-12 fractions for 3-4 days dosing for RIC TBI Ans- between 2-8gy over 1-4 fractions for single or multiple days GI side effects of TBI Ans- N+V Gastroenteritis