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35 Cards in this Set

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What cell surface receptors are on stem cells?
CD34
What are key phenotypic characteristics of stem cells?
Large nucleus

Little cytoplasm

Open chromatin
Why does stem cell transplantation help when administering chemotherapy?
Helps to overcome dose-limiting toxicity of chemotherapy
- Can give higher dose chemotherapy
At what level of neutropenia and below is there a great risk of infection?
< 500 neutrophils / mm3
When neutropenic, what is the chronological sequence of types of infection?
1. Bacterial infection

2. Fungal infection

3. Viral infection
From where are stem cells obtained during an autologous stem cell transplantation?
From the patient
What is the generic chemotherapeutic protocol and when in this protocol are autologous stem cells harvested and transplanted?
1. Induction
- Induction of remission by chemotherapy

2. Mobilization
- Chemotherapy with growth factors (GCSF) to mobilize stem cells from bone marrow to peripheral blood; these cells are collected and frozen

3. Conosolidation:
- High dose chemotherapy with growth factors (GCSF) and infusion with autologous stem cells
What are two ways in which stem cells are collected?
Marrow harvested from posterior superior iliac spine

Peripheral blood stem cell collection
How are stem cells collected from peripheral blood?
Stem cells mobilized via growth factors

Stem cells collected from buffy coat of peripheral blood (separated by CD34 count)
What growth factors are commonly used to mobilize stem cells from the bone marrow to the peripheral blood?
GCSF

AMD 3100
How does G-CSF mobilize stem cells from the bone marrow into the blood?
Stimulates granulocytes to secrete metalloproteinases that disrupt the binding of stem cells from bone marrow stromal cells and cause stem cells to enter the peripheral blood

Stimulate macrophages that do the same without metalloproteinases
How does AMD 3100 mobilize stem cells from the bone marrow into the blood?
Direct inhibitory effect on attachment of stem cell and stromal bone marrow cell
What are the attachment proteins that join stem cells and stromal cells of bone marrow?
Stem cell:
- CXCR4

Stromal bone marrow cell:
- SDF-1
In what conditions are autologous stem cell transplantation used?
Multiple myeloma

Lymphoma: after 1 remission and relapse
From where do stem cells come during an allogeneic stem cell transplant?
Donor
What are the antigens considered during HLA typing?
HLA class I:
- HLA-A
- HLA-B
- HLA-C

HLA class II:
- HLA-DP
- HLA-DQ
- HLA-DR
On what chromosome are the HLA genes found?
Chromosome 6
What cells have MHC I antigens?
All nucleated cells
What cells have MHC II antigens?
APCs:
- B cells
- Monocytes
- Macrophages
- Activated T cells
What cells bind MHC I antigens and what cells bind MHC II antigens?
MHC I:
- CD8 T cells

MHC II:
- CD4 T cells
By what pattern are HLA genes inherited?
Mendelian inheritance
What are the types of allogeneic stem cell donors and what level of HLA matching must they exhibit with the recipient?
Matched siblings

Matched unrelated donor (10/10)

Cord blood (4/6)

Haplo-identical donor (3/6)
What is the probability of having an HLA matched sibling?
25%
What is the major risk of an allogeneic stem cell transplantation from cord blood?
Risk of infection
When is the allogeneic stem cell transplant administered to the recipient over the course of their treatment?
Consolidation:
- High dose chemotherapy with growth factors
What is the difference between harvesting stem cells from an allogeneic donor and the autologous harvest?
Allogeneic donor does not require chemotherapy during the collection of stem cells
The treatment of what conditions use allogeneic stem cell transplantation?
Acute myeloid leukemia

Acute lymphoblastic leukemia

Myelodysplastic syndrome

Myelofibrosis or CMML

CHronic myeloid leukemia (that does not respond to tyrosine kinase inhibitors)

Lymphoma: refractory or relapse

Multiple myeloma: high risk and young patients

Aplastic anemia: patients < 40 years old
What are the goals of the preparative regimen before stem cell transplantation?
Destroy malignant cells via chemotherapy

Overcome immunologic barrier to engraftment
What is the graft vs. leukemia effect and when is it seen?
The new immune system fights diseased leukemic cells of the patient

Seen in allogeneic stem cell transplantation (not autologous stem cell transplant)
What are the two types of chemotherapeutic regimens used prior to transplant?
Myeloablative regimen:
- Kill all abnormal and normal stem cells

Non-myeloablative regimen:
- Not as intense
What are risks of the myeloablative chemotherapeutic regimen used to prepare for a stem cell transplantation?
Risk of:
- Mucositis
- Diarrhea
- Veno-occlusive disorder
- Alopecia
- Pneumonitis
- Hemolytic-uremic syndrome
- Thrombotic microangiopathic anemia
Why does the non-myeloablative chemotherapeutic regimen still allow for successful stem cell transplantation therapy?
Still works because of graft vs. leukemia effect

Also, supplement with donor lymphocyte infusion (DLI)
What are risks of the non-myeloablative chemotherapeutic regimen used to prepare for a stem cell transplantation?
Increased risk of relapse
In what patient populations are myeloablative chemotherapy vs. non-myeloablative chemotherapy used?
Myeloablative:
- Young patients

Non-myeloablative:
- Elderly patients
- Instances of complete remission
- Slowly progressing diseases
What are the symptoms of acute and chronic graft vs. host disease?
Acute:
- Skin rash
- Diarrhea
- Nausea
- Jaundice

Chronic:
- Scleroderma
- Lichen planus
- Bronchiolitis abliterans