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Hematopoietic Stem C

Hematopoietic Stem Cell Transplant

QuestionAnswer
Human cell surface markers (HLA) Used by immune system to recognize foreign cells Class I & II antigens: determined by several genes Many alleles for each gene
Inheritance (HLA) 1 set of antigens from each parent (total of 10 typed) Biological parent 5/10 match Full siblings 1 in 4 chance of being 6/6 or 10/10 match
Tissue typing for Autologous Donor Donor is patient itself so no problems and all maker molecules match
Tissue type for Synegeic donor Identical twin all maker molecules match
Allogenic donor a related donor or unrelated donor, only some marker molecules match
What is the purpose of autologous HSCT? is to rescue after high dose therapy to eliminate malignancy
What is the purpose of Allogeneic HSCT? purpose is to replace diseased marrow and provide Graft v. Tumor effect
How is HSCT done in older adults ? don’t aggressively remove bone marrow but will still will replace
What is the process pre-transplant HSCT? Oncologist refers patient to BMT service Lengthy complex consent form
What happens in day -10 to day 0 HSCT? Admission (relocation of family to BMT unit; orientation to unit protocol; CVL placed (if not already done) and conditioning Conditioning: High-dose chemotherapy and/or TBI; biologic response modifiers; antiemetics
What happens on day 0 HSCT? Transplant day: autologous, purged, unpurged, peripheral stem cells; allogeneic, T-depleted, related, unrelated; syngeneic.
What happens day Day +1 - +14 HSCT? Aplasia to engraftment Aplasia: toxicity due to conditioning regimen; analgesics; infection prophylaxis and treatment; blood products; TPN; GVHD prophylaxis; VOD Engraftment: viral prophylaxis continues; GVHD prophylaxis and treatment; toxicities begin
What happens Day +30 HSCT? varies, can be as early as 15 for auto Discharge: social and ADL restrictions to prevent infection; interstitial pneumonia; viral prophylaxis continues; GVHD meds
What happens Day +31- +100 HSCT? Postdischarge: long-term follow up; integration
What happens Day +100 to 1 year HSCT? Allos continue care by BMT service
What are the HSCT conditioning regimen? Eradication/Myeloablation Kills tumor cells In process destroys bone marrow Empties bone marrow space Provides room for growth of healthy cells Immunosuppression Prevents rejection of graft
What happens before patient receives myeloblative alleogenic transplant? allogeneic transplants--the most common type--patients with blood cancers must undergo a conditioning regimen of high-dose chemotherapy or radiation to kill any resident cancer cells, suppress the patient's immune system &leave a disease-free environment
What is a mini-transplant? Nonmyeloablative (Mini); AKA Reduced Intensity Conditioning. Sufficient immunosuppression to allow donor cell engraftment but less aggressive Injury to organs less, fewer infections, fewer transfusions Higher relapse rates
What are the possible side effects of infusion of stem cells? Nausea, possible fever spike from DMSO , or allergic reaction
Fresh stem cells have to be infused within what time? within 24 hours of collection, slow central venous catheter
Time to engraftment depends on Stem cell source (cord blood takes longer) Cell dose GCSF/GMCSF may be given to promote Average 10-14 days for peripheral stem cells, 14-21 days marrow and cord blood
Evidence of engraftment ANC >500 Platelets ≥ 20,000 without transfusion
What are immediate complications of transplant within first week? Nausea/vomiting Diarrhea Hemorrhagic cystitis Stomatitis – worse withTBI Mucositis Pancytopenia
What are the delayed complication of transplant between 7-60 days? Anorexia Bone marrow suppression Infections – viral, bacterial, fungal Capillary leak syndrome Pulmonary hemorrhage/ pneumonitis Veno-occlusive disease (VOD) Hemorrhagic cystitis/acute renal failure Graft failure Acute GVHD
What are the late complications of transplant after 60 days Late – after 60 days Immunosuppression Chronic GVHD Cataracts Endocrine dysfunction Pulmonary restrictive diseases Infection Bacteria/fungal/PCP/CMV/varicella Second malignancies
1 in 2 have symptoms of : GVHD – shows up within first 6 months, sometimes up to 2 years later
What is the discharge criteria for HSCT? ANC ≥ 500 for 2 days Afebrile Off IV antibiotics for 48 hours Able to eat and take oral medications
What family education should be provided for HSCT? When and who to call list Follow up in clinic Caring for central line(s) Medications Permitted activities Nutrition Signs & Symptoms of problems
All of the following are standing orders for a first fever spike following stem cell transplant. Which one should the nurse act on first? Blood cultures times two(central and peripheral)
A stem cell transplant survivor comes to the clinic for a follow up visit on day +150. She describes skin rashes and mouth pain, as well as dry eyes and blurred vision. The nurse should further inquire about which of these related symptoms? Vaginal dryness and sexual discomfort
Mrs. L., a 42-year-old female with non-Hodgkin’s lymphoma (NHL), is considering a stem cell transplant. She asks the nurse what the difference is between a stem cell transplant and a bone marrow transplant (BMT). What is the nurse’s best response? “A BMT is one type of stem cell transplant. The only difference is the source of the stem cells.”
Mrs L. has decided to undergo a bone marrow transplant (BMT). The nurse explains that as part of her preparation for a BMT, she will complete a conditioning process that involves: High-dose chemotherapy and total body irradiation to destroy the bone marrow
On day +21, the BMT nurse notes that Mrs L.’s WBC, RBC, and platelet counts are increasing. The nurse would be correct in interpreting this finding as evidence that: The transplant has engrafted
Created by: UARN85