Bone Marrow Transplant and Stem Cell Therapy Flashcards
6 cards from real CPHON practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 6 Bone Marrow Transplant and Stem Cell Therapy flashcards as text
A pediatric patient undergoing allogeneic hematopoietic stem cell transplant (HSCT) develops a skin rash, diarrhea, and elevated bilirubin 3 weeks post-transplant. The nurse recognizes this as which complication?
Answer: Acute graft-versus-host disease (aGVHD)
Acute GVHD classically presents within 100 days of allogeneic HSCT with involvement of skin (maculopapular rash), GI tract (diarrhea, cramping, nausea), and liver (elevated bilirubin, alkaline phosphatase).
Which conditioning regimen used prior to HSCT is associated with the highest risk of veno-occlusive disease (VOD)/sinusoidal obstruction syndrome?
Answer: Myeloablative conditioning with busulfan and cyclophosphamide
High-dose busulfan combined with cyclophosphamide in myeloablative conditioning regimens causes the most significant hepatic sinusoidal endothelial cell injury, leading to VOD/SOS.
What is the primary purpose of the preparative (conditioning) regimen given before HSCT?
Answer: To eradicate residual malignancy and create marrow space for donor cells
The conditioning regimen serves the dual purpose of destroying residual malignant cells (eradication) and creating immunosuppression and physical space in the bone marrow to allow engraftment of donor hematopoietic stem cells.
A child 6 months post-allogeneic HSCT develops dry eyes, oral mucosal changes, joint contractures, and skin tightening. This clinical picture is most consistent with:
Answer: Chronic graft-versus-host disease (cGVHD)
Chronic GVHD is a multi-system inflammatory and fibrotic disorder occurring after 100 days post-transplant, resembling autoimmune connective tissue diseases with features of scleroderma, Sjögren's, and lichen planus.
What is engraftment, and what laboratory finding confirms that it has occurred following HSCT?
Answer: Recovery of donor-derived hematopoiesis, confirmed by absolute neutrophil count (ANC) ≥500/µL for 3 consecutive days
Engraftment is defined as the successful establishment of donor hematopoietic stem cells in the recipient's bone marrow, with the primary indicator being an ANC of ≥500/µL (some use ≥500 for 3 days or ≥1000 for 1 day).
Which infection is of greatest concern during the pre-engraftment phase of HSCT (days 0–30) when the patient is profoundly neutropenic?
Answer: Bacterial and fungal infections
During profound neutropenia in the pre-engraftment phase, bacterial (gram-positive and gram-negative) and invasive fungal infections (Aspergillus, Candida) pose the greatest immediate threat to life.