Cord Blood Cord Blood Transplantation 2 — Questions and Answers
Question 1: What is acute graft-versus-host disease (aGVHD) and when does it typically occur after cord blood transplant?
- Recipient cells attacking donor cells, occurring after 100 days
- Donor T-cells attacking recipient tissues, occurring within 100 days of transplant (Correct answer)
- A fungal infection occurring at engraftment
- An immune reaction to chemotherapy drugs
Correct answer: Donor T-cells attacking recipient tissues, occurring within 100 days of transplant
Acute GVHD occurs when donor T-cells recognize host tissues as foreign and mount an immune attack, typically occurring within 100 days of transplantation.
Question 2: What is a reduced-intensity conditioning (RIC) regimen and why is it used?
- A regimen using full-dose radiation only
- A lower-intensity chemotherapy/radiation regimen used for older or medically frail patients (Correct answer)
- A protocol using no drugs before transplant
- A regimen reserved for pediatric patients only
Correct answer: A lower-intensity chemotherapy/radiation regimen used for older or medically frail patients
RIC regimens use lower doses of chemotherapy and/or radiation to reduce toxicity, making cord blood transplantation accessible to older patients or those with comorbidities who cannot tolerate full myeloablative conditioning.
Question 3: What is chronic graft-versus-host disease (cGVHD) and how does it differ from acute GVHD?
- cGVHD occurs within 30 days and affects only the skin
- cGVHD occurs after 100 days and can mimic autoimmune diseases affecting multiple organs (Correct answer)
- cGVHD is caused by recipient cells attacking donor cells
- cGVHD and aGVHD are identical conditions
Correct answer: cGVHD occurs after 100 days and can mimic autoimmune diseases affecting multiple organs
Chronic GVHD develops after 100 days post-transplant and can resemble autoimmune disorders, affecting multiple organ systems including skin, eyes, mouth, lungs, and gut.
Question 4: Which immune cells are the primary mediators of graft-versus-host disease after cord blood transplantation?
- Natural killer cells
- Donor T-lymphocytes (Correct answer)
- Recipient B-cells
- Donor neutrophils
Correct answer: Donor T-lymphocytes
Donor T-lymphocytes are the primary effector cells that recognize and attack host tissues, causing graft-versus-host disease.
Question 5: What is the role of calcineurin inhibitors like cyclosporine or tacrolimus in cord blood transplantation?
- They promote faster engraftment
- They are used as GVHD prophylaxis by suppressing donor T-cell activation (Correct answer)
- They increase stem cell collection yields
- They prevent viral reactivation only
Correct answer: They are used as GVHD prophylaxis by suppressing donor T-cell activation
Calcineurin inhibitors suppress T-cell activation by blocking calcineurin-mediated signaling, and are the cornerstone of GVHD prophylaxis regimens after cord blood transplantation.
Question 6: What is the main advantage of cord blood availability compared to matched unrelated donor bone marrow?
- Cord blood is always cheaper
- Cord blood units are banked and can be quickly retrieved, reducing time-to-transplant (Correct answer)
- Cord blood requires no HLA matching
- Cord blood units are always larger than bone marrow harvests
Correct answer: Cord blood units are banked and can be quickly retrieved, reducing time-to-transplant
Banked cord blood units can be identified and shipped within days, whereas identifying and mobilizing an unrelated bone marrow donor can take weeks to months.
Cord Blood Cord Blood Transplantation 2
What is acute graft-versus-host disease (aGVHD) and when does it typically occur after cord blood transplant?