Podcast
Questions and Answers
Which of the following is the primary reason hematopoietic progenitor cells (HPCs) are collected and transplanted?
Which of the following is the primary reason hematopoietic progenitor cells (HPCs) are collected and transplanted?
- To serve as a bone marrow replacement following total-body irradiation or chemotherapy. (correct)
- To eliminate the need for future blood transfusions.
- To reduce the patient's dependence on immunosuppressive medications.
- To introduce novel pathogens into the recipient to stimulate immune responses.
What is a key characteristic of autologous HPC transplants, distinguishing them from allogeneic transplants?
What is a key characteristic of autologous HPC transplants, distinguishing them from allogeneic transplants?
- They involve a donor who is HLA-matched but unrelated to the recipient.
- They are exclusively used for treating genetic diseases.
- They always require more intense immunosuppressive therapy post-transplant.
- The HPCs are sourced from the patient themselves. (correct)
Which action is a primary goal of the National Marrow Donor Program (NMDP)?
Which action is a primary goal of the National Marrow Donor Program (NMDP)?
- To coordinate searches for HLA-matched adult donors and cord blood. (correct)
- To develop new chemotherapy regimens.
- To provide long-term care for transplant recipients.
- To manage the costs associated with HPC transplants.
In related HPC transplantation, what is the likelihood of a sibling being HLA-identical to the patient?
In related HPC transplantation, what is the likelihood of a sibling being HLA-identical to the patient?
What is a key advantage of using umbilical cord blood as a source of HPCs compared to adult HPCs?
What is a key advantage of using umbilical cord blood as a source of HPCs compared to adult HPCs?
During bone marrow collection (HPC-M), what anatomical site is most frequently used for aspiration?
During bone marrow collection (HPC-M), what anatomical site is most frequently used for aspiration?
What antigen's presence is used to identify hematopoietic progenitor cells (HPCs)?
What antigen's presence is used to identify hematopoietic progenitor cells (HPCs)?
What is the primary purpose of using cytokine analogs like G-CSF in HPC-A?
What is the primary purpose of using cytokine analogs like G-CSF in HPC-A?
What is the typical volume of umbilical cord blood collected for HPC-C?
What is the typical volume of umbilical cord blood collected for HPC-C?
Why are bacterial and fungal cultures performed on HPC products?
Why are bacterial and fungal cultures performed on HPC products?
What is the purpose of using a cryoprotective chemical like dimethyl sulfoxide (DMSO) when freezing HPCs?
What is the purpose of using a cryoprotective chemical like dimethyl sulfoxide (DMSO) when freezing HPCs?
What processing step is taken to bone marrow products before infusion to remove bone spicules, fat, and debris?
What processing step is taken to bone marrow products before infusion to remove bone spicules, fat, and debris?
What is the primary goal of recipient conditioning regimens prior to HPC transplantation?
What is the primary goal of recipient conditioning regimens prior to HPC transplantation?
In the context of ABO incompatibility in HPC transplants, what defines a 'major' incompatibility?
In the context of ABO incompatibility in HPC transplants, what defines a 'major' incompatibility?
Following HPC transplantation, what is 'engraftment' generally defined as?
Following HPC transplantation, what is 'engraftment' generally defined as?
What cell population mediates Graft-Versus-Host Disease (GVHD)?
What cell population mediates Graft-Versus-Host Disease (GVHD)?
What is the primary purpose of donor lymphocyte infusion (DLI) post-allogeneic transplant?
What is the primary purpose of donor lymphocyte infusion (DLI) post-allogeneic transplant?
Which action helps reduce the incidence of alloimmunization to HLA antigens in HPC transplant candidates?
Which action helps reduce the incidence of alloimmunization to HLA antigens in HPC transplant candidates?
Why is gamma irradiation performed on cellular blood components for potential HPC transplant recipients?
Why is gamma irradiation performed on cellular blood components for potential HPC transplant recipients?
In an ABO-mismatched HPC transplant, what blood group(s) can both the donor and recipient with Group O blood receive for red blood cell transfusions?
In an ABO-mismatched HPC transplant, what blood group(s) can both the donor and recipient with Group O blood receive for red blood cell transfusions?
Flashcards
Cellular Therapy
Cellular Therapy
Cells used for blood and bone marrow transplantation, containing hematopoietic stem cells (HSC).
HPC Transplantation
HPC Transplantation
The process of transplanting hematopoietic progenitor cells (HPCs) to replace, provide graft-versus-leukemia reaction, or replenish diseased bone marrow.
Categories of HPC Transplants
Categories of HPC Transplants
Three categories are autologous (from self), allogeneic (from another person), and syngeneic (from identical twins).
National Marrow Donor Program (NMDP)
National Marrow Donor Program (NMDP)
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Methods of HPC Collection
Methods of HPC Collection
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HPC Mobilization
HPC Mobilization
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CD34 Antigen
CD34 Antigen
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Cell Purging
Cell Purging
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Long-Term HPC Storage
Long-Term HPC Storage
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DMSO (Dimethyl Sulfoxide)
DMSO (Dimethyl Sulfoxide)
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Myeloablative Conditioning
Myeloablative Conditioning
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Major ABO Incompatibility
Major ABO Incompatibility
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Engraftment
Engraftment
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Graft-Versus-Host Disease (GVHD)
Graft-Versus-Host Disease (GVHD)
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Acute GVHD
Acute GVHD
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Chronic GVHD
Chronic GVHD
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Donor Lymphocyte Infusion (DLI)
Donor Lymphocyte Infusion (DLI)
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Transfusion-Associated GVHD
Transfusion-Associated GVHD
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Blood Products for HPC Transplant
Blood Products for HPC Transplant
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ABO-Mismatched Transplants
ABO-Mismatched Transplants
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Study Notes
Categories of HPC Donors
- HPC donors can be autologous (self), allogeneic (another person, related or unrelated), and syngeneic (twin or triplet)
HPC Donor Assessments
- HPC donors are evaluated through medical history, physical exams, lab tests, EKG, chest x-ray, and a review of their health history
National Marrow Donor Program (NMDP)
- The NMDP recruits donors, store and manage donor data
- Coordinate searches for donors, as requested by medical institutions
HLA Match Probability Among Siblings
- There is a 25% chance of an HLA match between siblings
Umbilical Cord Blood Donation
- Requires the mother's consent, a review of her medical history
- Requires lab testing of the mother, to ensure suitability for donation
Bone Marrow Collection (HPC-M)
- HPC-M involves collecting bone marrow through aspiration
- Donors undergo general or epidural anesthesia during collection
- May require red blood cell transfusion
Leukapheresis (HPC-A)
- HPC-A involves collecting HPCs from peripheral blood via leukapheresis
- Cytokines are used to mobilize HPCs into the bloodstream
Diseases Treated by HPC Transplantation
- Transplantation can treat leukemia, lymphoma, and multiple myeloma
Allogeneic Transplantation Risks
- Due to the associated risks, allogeneic transplantation is not often used for nonmalignant diseases
HPC Product Testing
- HPC products undergo testing for complete blood count, white blood cell differential, CD34+ cells, and viability
Cultures
- Bacterial and fungal cultures are essential after thawing, to asses for contamination
HPC Storage
- HPCs are stored either at 20°C to 24°C or at 4°C, or at -196°C
Cryoprotectant
- DMSO is used as a cryoprotectant to protect cells during freezing
Viability
- Viability can be assessed with either dye exclusion or flow cytometry
Freezing HPCs
- Requires slowly adding DMSO and freezing in a controlled-rate freezer at 1°C to 3°C per minute
Myeloablative Conditioning
- Myeloablative conditioning completely destroys the bone marrow and the immune system
Nonmyeloablative Conditioning
- Nonmyeloablative conditioning partially destroys bone marrow and the immune system
ABO Incompatibility in HPC Transplantation
- Major ABO incompatibility occurs when the donor's red blood cells are incompatible with the recipient's antibodies
- Minor ABO incompatibility occurs when the donor's plasma is incompatible with the recipient's red blood cells
Engraftment
- Defined by polymorphonuclear neutrophils greater than 500/µL (around 10 days) and platelets greater than 20,000/µL (about 15 days)
- Patient should no longer be red blood cell transfusion dependent (90 to 100 days)
Graft-Versus-Host Disease (GVHD)
- Defined as donor T cells attacking the recipient's cells and tissues
Acute vs. Chronic GVHD
- Acute GVHD occurs within the first 100 days after transplant
- Chronic GVHD occurs after 100 days
Donor Lymphocyte Infusion
- Donor lymphocyte infusion is used to treat relapse of chronic myelogenous leukemia
HPC Transplant Recipients
- Leukocyte-reduced and irradiated cellular products, are often used to reduce the risk of HLA alloimmunization, CMV transmission, and GVHD
- CMV seronegative cellular blood products may be selected
Transfusion
- Blood type selected must be compatible for both the donor and the recipient
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