1. Elimination or eradication of diseased, or porely functioning bone marrow
Corrolary is that the diseased marrow is replaced with healthy functioning marrow
2. Tumor Kill: Allows us to give very high doses of chemotherapy without worrying about marrow toxicity
3. Establish a clean slate for new marrow to take hold and fight remaining tumor
Diseases commonly treated by bone marrow transplant
Leukemia, lymphoma, multiple myeloma, severe aplastic anemia, fanconi anemia, dyskeratosis congenital, hemoglobinopathies (beta thalassemia, sickle cell), meylodysplastic and myeloproliferative disorders, germ cell tumors such as testicular cancer
True or False you can use nonmyeloablative therapy with an autologous transplant
False if you have an autologous transplant you have to kill with a full myeloablative therapy
High dose of chemotherapy and or radiation that is used for tumor kill, full marrow ablation.
Myeloablative
This ablation technique absolutely requires! Stem cell rescue
Myeloablative
What type of ablation is used for tumor kill
Myeloablative
What type of ablation is used for a graft vs tumor effect?
Both myeloablative and nonmyeloablative
Another name for reduced intensity chemotherapy or mini allo
Nonmyeloablative
This technique uses lower doses of chemotherapy to create a platform for stem cell transplant
Non-myeloablative
Type of bone marrow transplant using an Identical twin�s bone marrow or peripheral stem cells
Synergetic Allogenic stem cells
Type of bone marrow transplant using a donor with a HLA identical sibling/relative
Matched related allogenic
Related donor is not HLA identical to the recipient
Mismatched related allogenic
What are the three types of Related allogenic transplants?
Matched related
Mismatched related
Syngeneic
What are the 3 types of unrelated allogenic transplants?
Mismatched unrelated
Matched unrelated (MUD)
Cord blood
Donor is HLA identical to an unrelated person
Matched unrelated
Donor is not HLA identical to the recipient and is unrelated
Mismatched unrelated
Donor stem cells are take from an umbilical cord immediately after delivery of an infant
Cord blood
HLA (MHC) is found on chromosome __
6
Super Locus
Group of genes that relate to the immune system
4 factors considered when deciding what type of transplant and conditioning to give the recipient
patient diagnosis and disease stage
patients age
co-morbidities
degree of donor-patient match called HLA typing
What are the 2 types of Lymphoma
Hodgkins and non-Hodgkins
What are B symptoms?
Fever, night sweats (and day sweats), weight loss
Are B symptoms more common in NHL or Hodgkins disease?
Hodgkins disease
What types of NHL are treated with BMT? Not specific disease types of NHL
Chemo-sensitive disease in the first relapse
Low grade disease transformed into high grade
Standard treatment for relapsed disease
Aggressive lymphoma
BMT may be used upfront for patients with high risk disease, which has one or more of what 4 qualities?
Age > 60
High LDH
Stage 3 or 4
More than one extranodal site
Chronic inflammatory diseases such as Sjogren�s syndrome, celiac disease and RA are associated with what types of cancer?
B cell and T cell neoplasms
�Reed-Sternberg� cells
Hodgkin�s Disease
What are the two indications for BMT in patients with Hodgkin�s disease?
Patients who do not achieve a remission with first line therapy
First or subsequent relapse of disease
Hodgkin�s disease is CD ___ and CD ___ positive
15, 30
AML is a disease of (young or old) people?
Old
What is standard induction therapy for AML?
3+7 � daunorubicin for three days and cytarabine for 7 days
or 5 and 2 for older patients
What are some prognostic that determine factors for overall survial in AML?
Age, WBC >100K, preexisting disorder (MDS,chemo,radiation), and Cytogenetics (favorable, t8,21, inv6 poor, +8,-7,-5 or multiple aberrations)
Plasma cell cancer
Multiple myeloma
What is the standard treatment for Multiple myeloma?
Bone marrow transplant once disease burden has been reduced
When would you use BMT to treat a Germ cell tumor (testicular cancer) ?
If they only have partial response to therapy or refractory disease
Testicular cancer typically affects men of what age?
20-39
What types of diseases are treated with Autologous stem cell transplant?
Lymphoma (both NHL and HD), Multiple myeloma, Acute myeloid leukemia, Germ cell tumors
Stem cell collecting process from peripheral blood is called what?
Apheresis
Dilantin, sulfonamides, penicillin and hydralazine can all cause this symptom that mimics Lymphoma
Lymphadenopathy
Rapid progressive lymphadenopathy is a sign of _____ while waxing and waning lymphadenopathy is a sign of ____
Aggressive lymphoma, indolent lymphoma
3 Characteristics of Lymphadenopathy suggestive of lymphoma
significant size (greater than 1.5 by 1.5 cm)
persistence for more than 4 wks
progressive increase in size
What type of biopsy is best for suspicious lymph nodes?
Excisional
On pathology report of a lymph node you note the pathogist decribes a very large cell with abundant pale cytoplasm and two or more oval lobulated nuclei containing large nucleoli and it appears red on H+E stain. You know instantly it is what type of cancer?
It�s a Reed Sternberg cell indicative of Hodgkin�s disease
What types of disease are treated with Allogenic stem cell transplant?
