Flashcards MMD exam I.txt

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BostonPhysicianAssist
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Flashcards MMD exam I.txt
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2012-01-29 22:36:45
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Bone Marrow Transplant MMD II
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Bone Marrow Transplant Lecture
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  1. An Indolent dz characterized by an overproduction of functionally incompetent mature B lymphocytes, which are smaller than normal and long lived.
    Chronic lymphocytic leukemia CLL
  2. What is the most commonly occurring adult leukemia?
    CLL
  3. What are the signs and symptoms of Leukostasis?
    Respiratory distress, headaches, blurred vision, lethargy, priapism, slurred speech, confusion
  4. Smudge cell is found in what?
    Chronic lymphocytic leukemia, CLL
  5. 3 rationales for bone marrow transplantation
    • 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
  6. 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
  7. 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
  8. High dose of chemotherapy and or radiation that is used for tumor kill, full marrow ablation.
    Myeloablative
  9. This ablation technique absolutely requires! Stem cell rescue
    Myeloablative
  10. What type of ablation is used for tumor kill
    Myeloablative
  11. What type of ablation is used for a graft vs tumor effect?
    Both myeloablative and nonmyeloablative
  12. Another name for reduced intensity chemotherapy or mini allo
    Nonmyeloablative
  13. This technique uses lower doses of chemotherapy to create a platform for stem cell transplant
    Non-myeloablative
  14. Type of bone marrow transplant using an Identical twin�s bone marrow or peripheral stem cells
    Synergetic Allogenic stem cells
  15. Type of bone marrow transplant using a donor with a HLA identical sibling/relative
    Matched related allogenic
  16. Related donor is not HLA identical to the recipient
    Mismatched related allogenic
  17. What are the three types of Related allogenic transplants?
    • Matched related
    • Mismatched related
    • Syngeneic
  18. What are the 3 types of unrelated allogenic transplants?
    • Mismatched unrelated
    • Matched unrelated (MUD)
    • Cord blood
  19. Donor is HLA identical to an unrelated person
    Matched unrelated
  20. Donor is not HLA identical to the recipient and is unrelated
    Mismatched unrelated
  21. Donor stem cells are take from an umbilical cord immediately after delivery of an infant
    Cord blood
  22. HLA (MHC) is found on chromosome __
    6
  23. Super Locus
    Group of genes that relate to the immune system
  24. 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
  25. What are the 2 types of Lymphoma
    Hodgkins and non-Hodgkins
  26. What are B symptoms?
    Fever, night sweats (and day sweats), weight loss
  27. Are B symptoms more common in NHL or Hodgkins disease?
    Hodgkins disease
  28. 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
  29. 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
  30. 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
  31. �Reed-Sternberg� cells
    Hodgkin�s Disease
  32. 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
  33. Hodgkin�s disease is CD ___ and CD ___ positive
    15, 30
  34. AML is a disease of (young or old) people?
    Old
  35. 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
  36. 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)
  37. Plasma cell cancer
    Multiple myeloma
  38. What is the standard treatment for Multiple myeloma?
    Bone marrow transplant once disease burden has been reduced
  39. When would you use BMT to treat a Germ cell tumor (testicular cancer) ?
    If they only have partial response to therapy or refractory disease
  40. Testicular cancer typically affects men of what age?
    20-39
  41. What types of diseases are treated with Autologous stem cell transplant?
    Lymphoma (both NHL and HD), Multiple myeloma, Acute myeloid leukemia, Germ cell tumors
  42. Stem cell collecting process from peripheral blood is called what?
    Apheresis
  43. Dilantin, sulfonamides, penicillin and hydralazine can all cause this symptom that mimics Lymphoma
    Lymphadenopathy
  44. Rapid progressive lymphadenopathy is a sign of _____ while waxing and waning lymphadenopathy is a sign of ____
    Aggressive lymphoma, indolent lymphoma
  45. 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
  46. What type of biopsy is best for suspicious lymph nodes?
    Excisional
  47. 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
  48. What types of disease are treated with Allogenic stem cell transplant?
    Leukemia (AML, ALL, CML), myelodisplastic syndrome, myeloproliferative disease, marrow failure states, myeloma, lymphoma
  49. What are some Indications for Adult allogenic Transplant?
    AML, ALL, Myelodysplatic syndromes (pre-leukemia), CML, Lymphoma, Multiple Myeloma, Bone marrow failure states
  50. What are some indications for pediatric allogenic transplant?
    Hematologic Malignancies, hematologic disease or disorder, Immunodeficiencies, Genetic or metabolic disorder
  51. What are 4 reasons for increased treatment related mortality in older patients undergoing myeloablative transplantation?
    • Comorbid medical conditions- renal, cardiac, pulmonary
    • Complications of treatment prior to transplant
    • Increased incidence of graft vs. host disease after transplantation
    • Advanced age- treatment mortality and relapse rate are higher in older people
  52. What are 4 advantages of non-myeloablative treatment as opposed to myeloablative transplantation?
    • Less treatment related toxicity
    • Co-morbid disease is less of a barrier to transplantation
    • Less graft vs host disease
    • Less cost and improved quality of life
  53. What is the main drawback of non-myeloablative therapy?
    Increased incidence of relapse
  54. What are the 3 parts (1/3rds) of the Transplantation process?
    • Conditioning (chemotherapy)
    • Stem cell infusion and supportive care (neutropenia, complications and sx management)
    • Recovery and engraftment
  55. What are some common side effects of Conditioning therapy?
    Drug reactions, mucositis, nausea, vomiting, fatigue, alopecia, rash, organ damage (pulmonary toxicity, venooclusive disease, renal failure)
  56. SEs of cyclophosphamide
    Cardiovascular, genitourinary, endocrine
  57. SEs of Busulfan
    Neurotoxicity, delayed pulmonary toxicity
  58. Name some medications that are used to prevent graft vs host disease?
    Tacrolimus, sirolimus, rapamycin, methotrexate
  59. Donor cells attack the healthy cells of the recipient patient
    Graft vs host disease
  60. Sx of GvHD
    Maculopapular rash, nausea, vomiting, anorexia, profuse diarrhea, ileus or cholestatic hepatitis and occurs within 100 days of transplantation or DLI
  61. T or F patients who develop acute GvHD will not develpe chronic GvHD later
    F. they are actually at higher risk of cGvHD

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