HPC B guy notes
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| Do HPCs express ABO antigens? | No
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| Most common source of HPC transplant | autologous
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| 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)
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| 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
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| most common source for HPC transplantation: marrow, peripheral blood, or umbilical cord blood | peripheral blood by apheresis
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| lower risk of graft failure: A. HPC-apheresis or B. HPC-marrow | A.
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| lower risk of GVHD: A. HPC-apheresis or B. HPC-marrow | B.
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| 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
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| most common reason for autologous HPC transplant | multiple myeloma
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| most common reason for allogeneic HPC transplant | Acute myeloid leukemia
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| 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
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| In children who have HPC transplant for a solid tumor, the most common source is: A. Allogeneic B. Autologous | autologous
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| In children who have HPC transplant for a non-malignant indication, the most common source is: A. Allogeneic B. Autologous | Allogeneic
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| Best chance of finding compatible HPC donor is in | siblings
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| 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
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| 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
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| 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
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| 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
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| How are Cord blood donations collected? | Collection is generally by gravity drainage of placental blood into collection bag containing CPD anticoagulant
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| In allogeneic HPC, What is "major incompatibility?" | Major incompatibility 1) Donor with incompatible red cell antigen. RBCs in HPC are hemolyzed during infusion
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| In allogeneic HPC, What is "minor incompatibility?" | Minor incompatibility 1) Donor with incompatible red cell antibody. recipient RBCs are hemolyzed during infusion
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| Why are HPC-marrow specimens filtered? | HPC-M products filtered to remove bone fragments and debris
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| This chemical is used as a cryoprotectant for HPC specimens that are frozen. | 10% Dimethyl sulfoxide (DMSO)
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| most common complication of HPC infusion | DMSO toxicity
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| symptoms/signs of DMSO toxicity | 1) Flushing/rash 2) Nausea/vomiting 3) Chest tightness/wheezing/cough 4) Hypertension 5) Garlic odor on breath
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| how to prevent DMSO toxicity | 1. washing
2. divide infusion to limit DMSO exposure to less than 1mL DMSO /Kg recipient weight/day
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| most common complication after HPC transplant | mucositis, 90%
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| Factors in HPC transplant that increase risk of rejection | 1) Increasing HLA disparity 2) T-cell purging of the infusion product
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| Factors in HPC transplant that decrease risk of rejection | 1) Increased dose of HPCs in infusion 2) Dose-intense treatment regimens
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| Risk factor for acute Graft-vs.-Host Disease (GVHD) in HPC transpalnt | Risk more with HLA differences and increased T-cells in transplant
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| % of long-term survivors of allogeneic HPC transplants that get chronic GVHD | 40-50% of long-term survivors
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| 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
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| Briefly describe Graft-vs.-tumor effect (GVT) or “graft-vs.-leukemia” effect | 1)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
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| Problems inherent to ABO-mismatched HPC transplants | Immediate hemolytic transfusion reaction; Delayed hemolytic transfusion reaction; Pure red cell aplasia
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| 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
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| 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)
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| 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)
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| This modification can be done to blood products for HLA immunization prevention and CMV transmission prevention | leukoreduction
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| Irradiated cellular blood products are for prevention of this condition | TA-GVHD
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| 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)
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| 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)
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| 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)
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| 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)
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