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HPC B guy notes

QuestionAnswer
Do HPCs express ABO antigens? No
Most common type of HPC transplant autologous
Potential complications of Reduced-intensity conditioning (RIC) prior to HPC transplant a) Incomplete tumor cell destruction with resultant microchimerism b) Increased risk of acute Graft-vs.-Host Disease (GVHD)
Potential advantages of Reduced-intensity conditioning (RIC) prior to HPC transplant 1. fewer complications during conditioning 2. Allows transplanted immune system to destroy tumor cells (“Graft-vs.-Tumor effect” 3. allows older and higher risk patients access to transplants that may have been too toxic with standard conditioning
most common source for HPC transplantation apheresis
lower risk of graft failure: A. HPC-apheresis or B. HPC-marrow A.
lower risk of GVHD: A. HPC-apheresis or B. HPC-marrow B.
Advantages of Cord blood transplants Naïve immune cells in cord blood make these transplants: a) Less likely than HPC-A or HPC-M to cause GVHD b) Less likely to fail due to HLA mismatch with recipient
most common reason for autologous HPC transplant multiple myeloma
most common reason for allogeneic HPC transplant Acute myeloid leukemia
In children, the most common indication for HPC transplant is: Childhood solid tumors (Neuroblastoma, Wilm’s, Ewing sarcoma, etc.); vast majority of these transplants are autologous
In children who have HPC transplant for a solid tumor, the most common source is: A. Allogeneic B. Autologous autologous
In children who have HPC transplant for a non-malignant indication, the most common source is: A. Allogeneic B. Autologous Allogeneic
Best chance of finding compatible HPC donor is in siblings
describe a "perfect" HPC match HLA-A, HLA-B, HLA-C (Cw), HLA-DRB1 alleles (“8 of 8 match”); tested by high resolution (DNA) methods
In HPC donations, Infectious disease screening is performed including • Hepatitis B (anti-HBc, HBsAg) • Hepatitis C (anti-HCV, HCV NAT) • HIV (anti-HIV-1,2, HIV NAT) • HTLV-I/II (anti-HTLV-I/II) • Cytomegalovirus (CMV) • Also syphilis, West Nile Virus, Chagas’ Diseas
Mobilization of CD34+ cells into peripheral blood (HPC-A collections) a) Cytokines cause HPC to migrate from marrow into circulation • G-CSF (granulocyte-colony stimulating factor) – Given daily (10 µg/Kg/day); peak effect on day _? day 5
Compare HPC-A to HPC-M with regards to RBCs, plasma, and T lymphocytes By comparison to HPC-A, HPC-M products have many more RBCs and much more plasma, but 10X fewer T-lymphocytes
How are Cord blood donations collected? Collection is generally by gravity drainage of placental blood into collection bag containing CPD anticoagulant
In allogeneic HPC, What is "major incompatibility?" Major incompatibility 1) Donor with incompatible red cell antigen. RBCs in HPC are hemolyzed during infusion
In allogeneic HPC, What is "minor incompatibility?" Minor incompatibility 1) Donor with incompatible red cell antibody. recipient RBCs are hemolyzed during infusion
Why are HPC-marrow specimens filtered? HPC-M products filtered to remove bone fragments and debris
This chemical is used as a cryoprotectant for HPC specimens that are frozen. 10% Dimethyl sulfoxide (DMSO)
most common complication of HPC infusion DMSO toxicity
symptoms/signs of DMSO toxicity 1) Flushing/rash 2) Nausea/vomiting 3) Chest tightness/wheezing/cough 4) Hypertension 5) Garlic odor on breath
how to prevent DMSO toxicity 1. washing 2. divide infusion to limit DMSO exposure to less than 1mL DMSO /Kg recipient weight/day
most common complication after HPC transplant mucositis, 90%
Factors in HPC transplant that increase risk of rejection Factors that increase risk for rejection: 1) Increasing HLA disparity 2) T-cell purging of the infusion product
Factors in HPC transplant that decrease risk of rejection Factors that decrease risk for rejection: 1) Increased dose of HPCs in infusion 2) Dose-intense treatment regimens
Risk factor for acute Graft-vs.-Host Disease (GVHD) in HPC transpalnt Risk more with HLA differences and increased T-cells in transplant
% of long-term survivors of HPC transplants that get chronic GVHD 40-50% of long-term survivors
Which specimen has a higher rate of Chronic GVHD: A. HPC-Apheresis B. HPC-marrow HPC-A recipients: less aGVHD, greater cGVHD vs. HPC-M recipients
Briefly describe Graft-vs.-tumor effect (GVT) or “graft-vs.-leukemia” effect Newly formed lymphocytes may act to destroy residual tumor cells, leading to better survival and decreased recurrence 2) As such, this is a beneficial form of GVHD, and is used intentionally in reduced-intensity conditioning allogeneic HPC transplants
Problems inherent to ABO-mismatched HPC transplants Immediate hemolytic transfusion reaction; Delayed hemolytic transfusion reaction; Pure red cell aplasia
describe how pure red cell aplasia might occur in a HPC transplant. 1) Consequence of the combination of major ABO incompatibility and survival of recipient plasma cells making ABO antibodies 2) Reticulocytopenia and absent RBC precursors in marrow at 60 days after transplant
Name the Pulmonary complication similar to TRALI clinically where HPC transplant patient develops Fever, hypoxia, and may progress to diffuse alveolar hemorrhage Engraftment syndrome (idiopathic pulmonary syndrome)
A patient with acute leukemia who is considering HPC transplant needs a RBC transfusion. The family would like to donate units for the patient. What do you think? avoid family member transfusions to prevent exposure to family HLA antigens (siblings are often best donors)
This can be done to blood products for HLA immunization prevention and CMV transmission prevention leukoreduction
Irradiated cellular blood products are for prevention of this condition TA-GVHD
In the peritransplant period, Transfuse these blood types for HPC transplant patients with Major ABO incompatibility Transfuse the recipient’s RBC type (or group O) and donor’s FFP/platelet type (or group AB)
In the peritransplant period, Transfuse these blood types for HPC transplant patients with Minor ABO incompatibility Transfuse the donor’s RBC type (or group O) and recipient’s FFP/platelet type (or AB)
When is engraftment expected in HPC transplants? within 100 days of transplant; usually happens much faster (10-30 days for PMNs, > 15 days for PLTs)
Engraftment speed varies by source: which is the fastest HPC-Apheresis, HPC-Cord, or HPC-marrow? Engraftment speed varies by source (HPC-A and –C faster than –M)
Created by: jfshikle