Stem Cell Transplantation Overview
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Questions and Answers

What is the required criteria for absolute neutrophil count (ANC) to consider engraftment successful?

  • ANC > 0.5 X 10<sup>9</sup> cells per liter
  • ANC > 500 cells/mm<sup>3</sup> (correct)
  • ANC > 1.0 X 10<sup>9</sup> cells per liter
  • ANC > 250 cells/mm<sup>3</sup>

    • During which phase after a stem cell transplant does the nadir typically occur?

  • Day 100
  • Day 30
  • Day 10 (correct)
  • Day 0

    • What percentage of patients receiving stem cell transplants experience acute graft versus host disease (GVHD)?

  • 75%
  • 30%
  • 50% or more (correct)
  • 25%

    • Which of the following is NOT a criterion for assessing engraftment?

    <p>Presence of transfusion requirements (B)</p> Signup and view all the answers

    What complication is characterized by the donor's white blood cells attacking the recipient's body tissues?

    <p>Acute graft versus host disease (GVHD) (D)</p> Signup and view all the answers

    What treatment may be administered to help recover white blood cell counts during neutropenia?

    <p>Colony-stimulating factor (C)</p> Signup and view all the answers

    Which organ is NOT commonly affected by acute graft versus host disease (GVHD)?

    <p>Kidneys (A)</p> Signup and view all the answers

    What is the primary risk associated with the nadir period following stem cell transplant?

    <p>Risk of infection (A)</p> Signup and view all the answers

    What is a significant challenge faced by infused hemopoietic stem cells during transplantation?

    <p>The recipient’s immune system may recognize them as foreign. (D)</p> Signup and view all the answers

    Which of the following statements about hemopoietic stem cell sources is correct?

    <p>Bone marrow provides a lower incidence of graft vs. host disease compared to peripheral blood. (C)</p> Signup and view all the answers

    What does the term 'HLA match' refer to?

    <p>The number of HLA molecules shared between donor and recipient. (D)</p> Signup and view all the answers

    Why is there a risk of HLA disparity in cord blood stem cell transplantation?

    <p>Cord blood has a smaller volume of available cells. (D)</p> Signup and view all the answers

    What function do HLA antibodies serve in a stem cell transplantation context?

    <p>They can attack transplanted cells that don't match the recipient’s HLA. (D)</p> Signup and view all the answers

    What is a disadvantage of utilizing peripheral blood stem cells over bone marrow?

    <p>They result in a higher incidence of graft vs. host disease. (A)</p> Signup and view all the answers

    During a stem cell transplant, what is generally required post-infusion?

    <p>Monitoring for signs of opportunistic infections. (A)</p> Signup and view all the answers

    What does stem cell transplant typically occur after?

    <p>An extensive preparation of the recipient including chemotherapy. (A)</p> Signup and view all the answers

    What is the main advantage of autologous stem cell transplants?

    <p>No foreign antigens present (D)</p> Signup and view all the answers

    Which type of donor is considered a matched related donor in allogeneic transplants?

    <p>A sibling with shared HLA antigens (B)</p> Signup and view all the answers

    What is myeloablation most commonly associated with in patient preparation for transplant?

    <p>Eliminating native blood stem cells (A)</p> Signup and view all the answers

    What defines the success of engraftment after a stem cell transplant?

    <p>Maintenance of a minimum number of white blood cells for a certain duration (C)</p> Signup and view all the answers

    In allogeneic transplants, which of the following describes a mismatched family donor?

    <p>A close relative without common HLA antigens (D)</p> Signup and view all the answers

    Which treatment is a common agent used in the myeloablation regime?

    <p>Cyclophosphamide (D)</p> Signup and view all the answers

    How long does the engraftment process typically take from the time of transplantation?

    <p>14-28 days (B)</p> Signup and view all the answers

    What is the key feature of syngeneic transplants?

    <p>Stem cells derived from an identical twin (A)</p> Signup and view all the answers

    What activities should be avoided for up to one year after receiving a transplant?

    <p>Contact sports, yoga, household chores (C)</p> Signup and view all the answers

    Which test is NOT included in the evaluation for subacute transplant patients?

    <p>Quality of Life Assessment (A)</p> Signup and view all the answers

    What is the primary reason for improved outcomes in heart transplantation since the first surgery in 1967?

    <p>Improved immunosuppressive drugs (B)</p> Signup and view all the answers

    Which of the following conditions is a contraindication for heart transplantation?

    <p>Chronic liver disease (A)</p> Signup and view all the answers

    What is the median survival range for adult heart transplant recipients?

    <p>10.7 to 12.2 years (A)</p> Signup and view all the answers

    What is the key difference between orthotopic and heterotopic heart transplant?

    <p>Orthotopic involves replacing the recipient's heart while heterotopic does not (A)</p> Signup and view all the answers

    Which factors are taken into account in the matching process for a heart transplant?

    <p>Blood type, disease severity, and geographical proximity (D)</p> Signup and view all the answers

    What percentage represents the one-year survival rate for heart transplant recipients?

    <p>82% (D)</p> Signup and view all the answers

    Which activity is considered low impact and is advisable during the subacute stage post-transplant?

    <p>Aerobic exercise (C)</p> Signup and view all the answers

    Which of the following tests is NOT typically part of the pre-transplant evaluation?

    <p>Thyroid function test (A)</p> Signup and view all the answers

    How does the mortality rate change in heart transplant patients after the first six months?

    <p>It decreases to 3.4% per year (D)</p> Signup and view all the answers

    What can lead to rejection of a donor heart by the transplant team?

    <p>Mismatch in tissue type (HLA) (D)</p> Signup and view all the answers

    What was the outcome of the first heart transplant performed in 1967?

    <p>Patient died 18 days after the procedure (A)</p> Signup and view all the answers

    Which immunosuppressive drug is known as a renal toxin?

    <p>Cyclosporine (C)</p> Signup and view all the answers

    What is a common result of chronic rejection after heart transplantation?

    <p>Transplant Coronary Artery Disease (TCAD) (D)</p> Signup and view all the answers

    What is the recommended frequency for heart biopsies after the first month post-transplant?

    <p>Monthly (D)</p> Signup and view all the answers

    Which physiological alteration is characterized by the inability to increase the heart rate appropriately?

    <p>Chronotropic incompetence (B)</p> Signup and view all the answers

    What is a significant musculoskeletal alteration observed in heart transplant recipients?

    <p>Decreased oxidative enzyme capacity (D)</p> Signup and view all the answers

    During physical activity, how is heart rate and cardiac output regulated in a transplanted heart?

    <p>Both circulating catecholamines and Bainbridge reflex (C)</p> Signup and view all the answers

    What is the size of the tissue sample collected during a cardiac biopsy?

    <p>Size of a pin (A)</p> Signup and view all the answers

    What type of drug is prednisone classified as in heart transplantation?

    <p>Immunosuppressant (A), Antirejection drug (B)</p> Signup and view all the answers

    Flashcards

    Bone Marrow Stem Cells

    Blood stem cells found in bone marrow, used for transplants.

    Peripheral Blood Stem Cells

    Blood stem cells collected from the bloodstream, used in transplants.

    Cord Blood Stem Cells

    Stem cells obtained from umbilical cord blood, used in transplants.

    HLA Matching

    Matching HLA (Human Leukocyte Antigen) molecules between donor and recipient for a stem cell transplant.

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    Graft-vs-Host Disease (GVHD)

    An immune reaction after a transplant where the donor's immune system attacks the recipient's tissues.

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    Stem Cell Transplant

    A medical procedure where a recipient receives stem cells from a donor to replace damaged or diseased blood cells.

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    HLA

    Human Leukocyte Antigens. Proteins on cells that determine if cells are self or non-self (foreign).

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    Engraftment

    The process by which transplanted cells begin to function in the recipient's body.

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    Autologous Stem Cell Transplant

    Stem cells from the patient are collected and re-injected.

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    Syngeneic Transplant

    Uses stem cells from an identical twin.

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    Allogeneic Transplant

    Stem cells are from a matching donor.

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    Matched Related Donor

    Stem cell donor is a close family member (e.g., sibling).

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    Matched Unrelated Donor (MUD)

    Stem cell donor is not a family member but shares HLA antigens.

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    Myeloablation

    Treatment using chemotherapy and radiation to kill patient's blood stem cells

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    Engraftment Success

    Maintaining sufficient WBC and platelets for a set period after transplant.

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    Engraftment criteria

    Specific blood cell counts (WBC, platelets, hemoglobin) maintained for 3 consecutive days after a transplant, along with no need for transfusions.

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    Engraftment time

    The process of the transplanted blood cell getting established, typically taking 14-28 days.

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    Absolute Neutrophil Count (ANC)

    A measure of the number of neutrophils, a type of white blood cell, in the blood. A critical indicator of immune function after a transplant.

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    Nadir

    The lowest point of blood cell counts after a stem cell transplant, a period of high infection risk.

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    Neutropenia

    A low neutrophil count (ANC) after a transplant, putting the patient at risk of infection.

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    Acute GVHD

    A severe complication after a stem cell transplant where the donor cells attack the recipient's tissues.

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    ANC value for engraftment

    A calculated value, a specific minimum (500 cells/mm³) indicating sufficient working neutrophil level for engraftment.

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    Post-transplant exercise recommendations

    Restrictions on physical activity for up to a year after transplantation to lower risk of infection.

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    Subacute transplant setting assessments

    Evaluation protocol for transplant recipients focusing on walking, cycling, strength, balance, and flexibility immediately after transplant.

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    Post-transplant mortality causes (subacute)

    Causes of death within 100 days post-transplant versus those dying after

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    Heart transplant candidates

    Patients with severe, chronic heart failure requiring mechanical or drug support (IABP & inotropes), or those with refractory acute heart failure.

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    Heart transplant survival

    Median survival time for adult recipients ranges from 10.7 to 12.2 years, with high early mortality rates (first 6 months).

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    6-minute Walk Test

    A clinical test measuring walking endurance in patients, frequently employed in transplant settings.

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    Time Up and Go (TUG)

    A clinical test to assess balance and mobility in patients. Often utilized in post-transplant settings

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    Subacute setting treatment

    Inpatient treatment continuation, including IV medications, and rehabilitation programs focusing on aerobic exercise, strength, balance, and flexibility for fall prevention.

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    Orthotopic Heart Transplant

    A surgical procedure where the recipient's diseased heart is removed and replaced with a donor's heart in the same location within the chest.

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    Heterotropic Heart Transplant

    A surgical procedure where a donor heart is implanted in the recipient's chest, but the recipient's diseased heart is not removed.

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    What are some contraindications for heart transplant?

    Contraindications for heart transplant include chronic liver disease (cirrhosis), advanced kidney disease, recent stroke, uncontrolled diabetes with end-organ damage, active malignancy, severe lung disease, and severe pulmonary hypertension.

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    What are some pre-transplant evaluations?

    Pre-transplant evaluations include laboratory tests (diagnostic tests, medical & surgical evaluation, psychosocial evaluation, psychiatric evaluation, nutrition evaluation, financial evaluation), and a dental clearance, ophthalmology consult, DEXA scan, colonoscopy, and a diaphragm nerve conduction study.

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    What factors affect transplant list ranking?

    Factors affecting transplant list ranking include severity of disease, blood type, tissue type (HLA), organ size, medical urgency, time on the waiting list, and distance between the donor and transplant center.

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    Anti-rejection drugs

    Medications used to prevent the body from rejecting a transplanted heart. They suppress the immune system, reducing the risk of the body attacking the new organ.

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    Renal failure after heart transplant

    Kidney damage caused by anti-rejection drugs or reduced blood flow to kidneys. This can be a serious complication.

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    Acute rejection

    The body's immune system attacking the transplanted heart shortly after surgery. This is a medical emergency.

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    Chronic rejection

    Long-term rejection of the transplanted heart leading to damage and scarring of heart tissue and blood vessels.

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    Transplant Coronary Artery Disease (TCAD)

    A condition that develops after heart transplant where the arteries supplying blood to the heart become narrow and hardened, reducing blood flow.

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    Cardiac Biopsy

    A procedure to remove a small sample of heart tissue to check for rejection and assess the heart's health.

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    Warm-up and cool-down

    Essential for heart transplant recipients as their heart rate doesn't change rapidly. Helps prepare and recover the body.

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    Sternal Precautions

    Limits on physical activity after heart surgery to protect the healing chest bone. Avoiding heavy lifting and pushing.

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    Study Notes

    Stem Cell Transplantation

    • Goal: Replace diseased bone marrow with healthy stem cells to produce functional blood cells. This normalizes hematopoiesis, the process by which the body produces blood cells.
    • Diseases Treated: Primarily blood tumors like leukemia, lymphoma, multiple myeloma, and myelodysplastic syndromes. Also used for neuroblastoma, Ewing sarcoma, brain tumors, germ cell tumors, and testicular cancer in children.
    • Stem Cell Types: Two main types:
      • Embryonic stem cells: Can differentiate into any cell type, have high plasticity, and are potential treatments for diseased organs and tissues.
      • Adult stem cells (somatic stem cells): Found in tissues and organs, differentiate into specialized cell types of that tissue or organ.
    • Hematopoietic Stem Cells:
      • The originating cell and stem cell
      • Differentiation: Process immature cells mature cells with specific functions.
      • Types: Myeloid stem cell, Lymphoid stem cell, Hematopoietic stem cells
    • Bone Marrow: Common source of stem cells; lower incidence of graft rejection and quicker engraftment.
    • Peripheral Blood Stem Cells: Quicker engraftment, greater risk of GVHD.
    • Umbilical Cord Blood: Contains stem cells; has lower stem cell count and longer engraftment period.
    • Sources of Hemopoietic Stem Cells: Bone marrow, peripheral blood stem cells, umbilical cord blood.
    • Types of Transplants:
      • Autologous: Stem cells collected from the patient and reinjected; low rejection risk.
      • Syngeneic: Stem cells from an identical twin; reduced rejection risk.
      • Allogeneic: Stem cells from a matching donor; higher rejection risk (graft-vs-host disease), is the most common source of bone marrow transplant.
    • Patient Preparation: Myeloablation, chemotherapy, and whole-body radiation to destroy the patient's native blood cells and makes way for new cells.
    • Infusion: Stem cells are infused into the patient after myeloablation.
    • Engraftment: The process where transplanted stem cells migrate to bone marrow, establish a stem cell population, and start producing new blood cells. (takes 14-28 days for complete development).
    • Nadir: Lowest point of blood cell counts after transplantation, this period has greatest risk of infection.
    • Graft vs. Host Disease (GVHD): A serious complication where the donor's immune cells attack the recipient's tissues.
    • Tissue Matching: Matching HLA (Human Leukocyte Antigens) is critical for reducing rejection risk.
    • Post-transplant setting: Includes isolation; good days, bad days, family involved; monitor blood counts; in-room and out-of-room exercise programs; 6 min walk test, cycling test, balancing exercises.
    • Subacute setting: 30-100 days after the transplant, limitations are present, includes out-patient vs HEP, ports, avoid high impact activities, monitor blood counts.
    • Exercise Behavior: Patient's exercise patterns vary, with some post-transplant recovery.
    • Physical Functional Status: Exercise impact on physical status, measured by strength.
    • Heart Transplant: Discusses candidates, types of procedures (orthotopic, heterotropic), contraindications, pre-transplant evaluation, the matching process, immunosuppression, early problems (renal failure, rejection), and cardiac biopsy. (Also contains information on physical activity, post-transplant CV & skeletal muscle alterations, effects of exercise, and exercise protocols)
    • Lung Transplant: Covers reasons for transplantation (COPD, interstitial lung disease, cystic fibrosis, pulmonary hypertension), factors affecting eligibility, surgical procedure, methods for transporting the lungs and connections to the recipient's body, complications, post-transplant care, and preservation techniques.

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    Stem Cell Transplantation PDF

    Description

    Explore the fundamentals of stem cell transplantation, including its goal of replacing diseased bone marrow with healthy stem cells. This quiz covers the diseases treated, types of stem cells, and the process of hematopoiesis, essential for producing functional blood cells.

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