BMT Vocabulary

Vocabulary flashcards covering key medical terms, transplant categories, procedures, and post-transplant complications from the LLS Blood and Marrow Stem Cell Transplantation guide.

Hematopoietic Stem Cells

Immature cells located in the bone marrow that can either divide to form more stem cells or mature into red blood cells, white blood cells, and platelets.

Bone Marrow

The spongy tissue found in the central cavity of certain bones where blood cell formation takes place.

Red Blood Cells

Blood cells filled with hemoglobin that pick up oxygen from the lungs, transport it throughout the body, and carry carbon dioxide back to the lungs.

White Blood Cells

Infection-fighting cells in the blood that are part of the immune system, including granulocytes, monocytes, and lymphocytes.

Platelets

Small cell fragments in the blood that stick together at injury sites to help control bleeding and form blood clots.

Conditioning Regimen

A treatment process consisting of chemotherapy with or without radiation therapy given prior to transplantation to destroy cancer cells, clear space in the marrow, and suppress the immune system.

Autologous Stem Cell Transplantation

A transplant procedure in which a patient's own stem cells are removed and frozen before conditioning, then re-infused into the body to restore blood cell production.

Allogeneic Stem Cell Transplantation

A transplant procedure in which a patient receives healthy stem cells from a related or unrelated donor after undergoing conditioning therapy.

Engraftment

The process in which transplanted donor or self stem cells migrate to the bone marrow and begin producing new, healthy blood cells.

Graft-Versus-Host Disease (GVHD)

A medical complication occurring in allogeneic transplants where donor T cells (the graft) view the patient's healthy tissue (the host) as foreign and attack it.

Graft-Versus-Tumor (GVT) Effect

An immune response in allogeneic stem cell transplantation where donor white blood cells recognize and attack remaining cancer cells in the recipient.

Reduced-Intensity Allogeneic Stem Cell Transplantation

An allogeneic transplant using lower, less toxic doses of chemotherapy and radiation, relying primarily on the graft-versus-tumor effect rather than high-dose therapy to fight cancer.

Human Leukocyte Antigens (HLAs)

Inherited proteins found on the surface of most cells that the immune system uses to distinguish self from non-self during tissue typing.

Haploidentical Transplantation

A type of allogeneic transplant that uses stem cells from a half-matched donor, typically a biological parent, child, or sibling.

Syngeneic Stem Cell Transplantation

An allogeneic transplant procedure where the donor and recipient are genetically identical twins.

Apheresis

A nonsurgical procedure in which donor blood is passed through a specialized machine to separate out stem cell-containing white blood cells while returning the remaining components to the donor.

Granulocyte-Colony-Stimulating-Factors (G-CSFs)

Injectable growth factor medications (such as filgrastim) given to donors to stimulate the release of stem cells from the bone marrow into the peripheral bloodstream.

Central Venous Catheter (CVC)

A flexible tube surgically placed into a large vein, usually in the upper chest, to allow direct administration of treatments, medications, and stem cells without repeated needle sticks.

Veno-Occlusive Disease (VOD)

A potentially severe liver complication following high-dose chemotherapy where small blood vessels carrying blood through the liver become obstructed; also known as sinusoidal obstructive syndrome.

Oral Mucositis

Painful mouth sores caused by high-dose conditioning chemotherapy damaging the epithelial cells lining the mouth and gastrointestinal tract.

Donor Lymphocyte Infusion (DLI)

An injection of white blood cells from the original donor given post-transplant to improve engraftment or strengthen anti-tumor immune effects.

Post-Transplant Lymphoproliferative Disorders (PTLDs)

A group of rare disorders causing uncontrollable lymphocyte growth after an allogeneic stem cell transplant, mostly caused by Epstein-Barr virus (EBV) (type of herpes virus). Typically occurs within a year of transplantation.

Extracorporeal Photopheresis (ECP)

A procedure used to treat acute GVHD where white blood cells are filtered outside the body, combined with 8-methoxypsoralen, exposed to UVA light, and returned to the patient.

Neutropenia

A condition characterized by lower-than-normal levels of neutrophils in the blood, leaving the patient extremely vulnerable to infection.

Thrombocytopenia

A condition in which there is a lower-than-normal number of platelets in the blood, leading to easy bruising and excessive bleeding.

Hematopoiesis

The continuous process of blood cell development, differentiation, and maturation occurring within the bone marrow.

Refractory Disease

A disease state that is resistant to or does not go into remission after initial treatment.

Relapse

The return or progression of a disease after a period of initial improvement or remission following treatment.

Bone Marrow Aspiration

If stem cells are collected from the bone marrow, a procedure called “bone marrow aspiration” is done. Bone marrow donation is a surgical procedure and is performed in an operating room, using either regional or general anesthesia. The doctor uses a special hollow needle that is attached to a syringe. The needle is inserted through the patient’s skin into one or more areas of the hip bone and the doctor withdraws bone marrow from the top edge of the hip bone of the donor. Several pints of marrow are removed. The donor usually remains in the hospital for about 6 to 8 hours, including recovery time.

Engraftment Order

White blood cells are the first cells to engraft, followed by platelets and then red blood cells. As engraftment occurs, the white blood cells, red blood cells and platelets will begin to increase in number.

Thrombocytopenia

A condition in which there is a lower-than-normal number of platelets in the blood (thrombocytes).

Calcineurin Inhibitors

Tacrolimus or Cyclosporine; suppress enzymes that activate the immune system

Immunosuppressants

Mycophenolate mofetil, Hydroxychloroquine, and Sirolimus; lower the body’s immune response

Coticosteriods

Methylprednisolone or prednisone; weaken the body’s immune response and reduce inflammation

Biologics

Abatecept, Antithymocyte Globuline (ATG), Alemtuzumab, or Tocilizumab; IV infusions that stop or slow inflammation

Chemotherapy Drugs

Cyclophosphamide or Methotrexate; eliminate certain donor T-Cells to help prevent GVHD

Acute GVHD

Usually develops within the first 100 days after transplantation, but it can occur later.

Extracorporeal Photopheresis (ECP)

Sometimes used to treat acute GVHD. In this procedure, the patient’s blood is circulated outside the body through a machine that filters it. The filter separates the white blood cells from the rest of the blood. The white blood cells are combined with a light-sensitive agent called 8-methoxypsoralen and then exposed to ultraviolet A (UVA) light to activate the medicine, which kills the immune cells. The treated cells are then returned to the patient’s body.

Ruxolitinib (Jakafi)

FDA-approved to treat adult or pediatric patients 12 years and older with acute GVHD, as a second-line treatment after therapy with steroids has failed.

Chronic GVHD

Syndrome that may involve a single organ or possibly many organs. It is one of the leading causes of medical problems and death after an allogeneic stem cell transplantation and it affects approximately 40% to 50% of patients. Chronic GVHD may occur at any time after transplantation, but it typically occurs at least 100 days after the day of transplant.

For patients who do not respond to prednisone orother steroid treatments, the Food and Drug Administration (FDA) has approved:

• Ibrutinib (Imbruvica®), taken by mouth, to treat adult and pediatric patients age 1 year and older with chronic GVHD after failure of one or more lines of systemic therapy

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• Ruxolitinib (Jakafi®), administered orally, to treat adult or pediatric patients 12 years and older with chronic GVHD after one or two lines of systemic therapy have failed

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• Belumosudil (Rezurock®), taken by mouth, to treat adult and pediatric patients 12 years and older with chronic GVHD after failure of at least two prior lines of systemic therapy

Plasma

Largely made up of water in which many chemicals are dissolved. These chemicals each have a special role. They include:

• Proteins

• Albumin - this is the most common blood protein.

• Blood-clotting proteins (coagulation factors) - made by the liver.

• Erythropoietin - made by the kidneys that stimulates red blood cell production.

• Immunoglobulins - cells that fight infection

• Hormones - ex: thyroid and cortisol

• Minerals - ex: iron and magnesium

• Vitamins - ex: folate and vitamin B12

• Electrolytes - ex: calcium, potassium and sodium

Red Blood Cells (RBC)

Cells that carry oxygen. Filled with hemoglobin (protein that picks up oxygen from the lungs, takes it around the body, binds to CO2, removes it from the cells and brings it back to the lungs to exhale.

Platelets

Cells that help blood clot; attach to the torn vessel, clump together and plug up the bleeding site

White Blood Cells (WBCs)

Cells that fight infections. Ex: neutrophils and monocytes (two types of phagocytes that ingest and destroy bacteria and fungi); eosinophils and basophils (respond to allergens or parasites); Lymphocytes (found in the lymph nodes, spleen, and the lymphatic channels of the immune system; T-cells, B-Cells, and Natural Killer (NK) Cells)

Anemia

A decrease in the number of red blood cells causing a decrease in the hemoglobin concentration of the blood. This results in diminished ability of the blood to carry oxygen. If severe, anemia can cause a pale complexion, weakness, fatigue and shortness of breath on exertion

Antigen

Any substance that causes the body to induce an immune response against that substance. Antigens include toxins, chemicals, bacteria, viruses, or other substances that come from outside the body.

Basophil

A type of white blood cell that fights against certain allergic reactions

B-Lymphocyte (B-Cell)

Specialized white cell that produces antibodies in response to any foreign substance, and especially in response to bacteria, viruses and fungi. There are three types of lymphocytes, which are a vital part of the immune system and are important in the body’s defense against infection.

Bone Marrow

The spongy tissue in the hollow central cavity of the bones, the site of blood cell formation. After puberty, the marrow in the spine, ribs, breastbone, hips, shoulders and skull is most active in blood cell formation. In adults, the bones of the hands, feet, legs and arms do not contain blood-forming marrow because in these sites the marrow is filled with fat cells.

Central Venous Catheter (CVC)

A tube inserted directly into a patient’s vein (intravenously) that is used to take blood samples and administer therapies, medications, and other treatments. The thin tube is inserted and guided into a large vein, usually below the collarbone. A central venous catheter may stay in place for weeks or months to avoid the need for repeated needle-sticks. Also known as a “central line.” The two most common types of central line are the (1) peripherally inserted central venous catheter (PICC or PIC Line) described above and the (2) implantable port.

Chemotherapy

The use of chemicals (drugs or medications) to stop the growth of cancer cells by either killing the cancer cells or by stopping them from dividing.

Growth Factor

A chemical used to stimulate the production of neutrophils and shorten the period of low neutrophil counts in the blood after chemotherapy. Granulocyte-colony stimulating factor (G-CSF) and granulocyte-macrophage colony-stimulating factor (GM-CSF) are examples of growth factors that are made commercially. GM-CSF can also stimulate monocytes.

Haploidentical Stem Cell Transplantation

Parents are always half-match donors for their children, and siblings have a 50 percent chance of being a half-match donor for each other.

Hematopoiesis

The process of blood cell development in bone marrow. Undeveloped cells called stem cells develop into young or immature blood cells such as red blood cells or white blood cells of various types in a process called “differentiation.”

Human Leukocyte-associated Antigens (HLA)

These antigens are proteins on the surface of most tissue cells that give individuals their unique tissue type

Lymph Nodes

Small structures, usually less than 1 centimeter, which contain large numbers of lymphocytes and are connected with each other by small channels called “lymphatics.” These nodes are distributed throughout the body.

Neutropenia

A decrease below normal in the number of blood neutrophils, a type of white blood cell.

Neutrophil

The principal phagocyte (microbe-eating cell) in the blood. This white blood cell is the main cell that combats infection. Insufficient quantities of neutrophils in patients who have acute leukemia (and in patients after chemotherapy) increases their susceptibility to infection.

Spleen

An organ located in the left upper portion of the abdomen just under the left side of the diaphragm. It contains clusters of lymphocytes and also filters old and worn-out cells from the blood. The spleen is often affected in lymphocytic leukemia and lymphoma.

T-Lymphocyte (T-Cell)

A type of white blood cell. T cells are part of the immune system that help protect the body from infection and may also help fight cancer.