immunohematology - stem cell transplant

hematopoietic stem cell transplant

complete replacement of an individual’s hematopoietic system; involves ablation of patients existing marrow then replacement with hematopoietic progenitor cells

CD34+

marker for progenitor cells

hematopoietic stem cell transplant

treatment for neoplastic conditions as well as congenital hematological diseases

bone marrow, peripheral blood, cord blood

what are the three sources of HSCs?

iliac crest

where is bone marrow harvested from in the donor that requires general anesthesia and an OR?

20

the maximum volume a donor can give of bone marrow is _____mL/kg of donor body weight

rG-CSF, plerixafor

the marrow in peripheral blood is stimulated with _____ about 5 days prior to collection and _____ to mobilize progenitor cells

umbilical cord blood

milked for maximum yield, samples collected for infectious disease and HLA typing, collection is washed and plasma reduced and the remainder is cryopreserved

plasma reduced

if bone marrow has a minor mismatch, then autologous units can be _____

red cell reduced

if there is a major mismatch of bone marrow, then it can be _____

ISO 7

all manipulation of HSC units must be performed in either a closed system or a _____ clean room

cryopreservation

short term or long term storage of bone marrow or PBSC, all cord blood

DMSO 10%

what is the cryoprecipitate solution used for HSC products?

LN2

cryopreserved units are frozen with _____ powered controlled rate freezer or in _____ vapor

fresh products of HSCs

administer by direct infusion asap, complete crossmatch is required

frozen products

administer by bringing to patient bedside on LN2, thaw with sterile water, push infused into patient quickly so that DMSO does not kill cells, patient will expel DMSO via respiration

G-CSF

patients recovering from transplant can receive _____ starting day 4 and continuing until not neutropenic

acute GVHD

risk that can happen in first 100 days post transplant, about 50% of matched donor transplants, high rates in grade 3 and 4

chronic GVHD

risk that happens >3 months after transplant, about 50% of all allogeneic transplants, 25% mortality

primary graft failure

risk that is complete failure of engraftment

secondary graft failure

risk that is loss of functioning graft

graft rejection

risk that host immune system attacks and destroys stem cell graft

CAR-T cell therapy

receptor combined with intracellular signaling domain to form chimeric molecule, modified T cells are programmed to attack specific tumor antigens (patient’s own cells used)

CD19 therapy (CAR-T)

used for relapsed/refractory B cell lymphomas and B cell ALL

B cell maturation antigen therapy (CAR-T)

used in multiple myeloma