BMTCN REVIEW CHAPTER 4 -
TRANSPLANT PREPARATIVE
REGIMENS, CELLULAR INFUSION,
ACUTE COMPLICATIONS, AND
ENGRAFTMENT WITH 100% CORRECT
ANSWERS
TRANSPLANT PREP REGIMENS - answer Treatment leading up to transplant
Acronyms:
Ara-C
BCNU
BU
Cy
DLT
SCT
TBI - answer Cytarabine
Carmustine
Busulfan
Cyclophosphamide
Dose limiting toxicity
DStem cell transplant
Total body irradiation
Induction chemotherapy - answer The first treatment given for a disease. It is often part of a
standard set of treatments, such as surgery followed by chemotherapy and radiation. When
used by itself, induction therapy is the one accepted as the best treatment. If it doesn't cure the
,disease or it causes severe side effects, other treatment may be added or used instead. Also
called first-line therapy, primary therapy, and primary treatment.
Consolidation chemotherapy - answer Treatment that is given after cancer has disappeared
following the initial therapy. Consolidation therapy is used to kill any cancer cells that may be
left in the body. It may include radiation therapy, a stem cell transplant, or treatment with drugs
that kill cancer cells. Also called intensification therapy and postremission therapy.
Maintenance chemotherapy - answer Treatment that is given to help keep cancer from coming
back after it has disappeared following the initial therapy. It may include treatment with drugs,
vaccines, or antibodies that kill cancer cells, and it may be given for a long time.
Mobilization chemotherapy - answer Stem cell mobilization: A process in which certain drugs
are used to cause the movement of stem cells from the bone marrow into the blood. The stem
cells can be collected and stored. They may be used later to replace the bone marrow during a
stem cell transplant.
Conditioning (preparative) chemotherapy - answer The treatments used to prepare a patient for
stem cell transplantation (a procedure in which a person receives blood stem cells, which make
any type of blood cell). A conditioning regimen may include chemotherapy, monoclonal
antibody therapy, and radiation to the entire body. It helps make room in the patient's bone
marrow for new blood stem cells to grow, helps prevent the patient's body from rejecting the
transplanted cells, and helps kill any cancer cells that are in the body.
History of SCT and Conditioning - answer Atomic bomb
TBI
1st Transplant 1956, -Dr.
Donnall Thomas
,Cyclophosphamide first chemotherapy to be used for SCT
Goal of Conditioning Regimens - answer Eradicate existing disease (for malignant)
Myeloablation (more for auto)
Immunosuppress recipient to prevent graft rejection
Preserve non-hematologic organs
What Class of Chemotherapy? (And MOA)
Melphalan
Carmustine
Busulfan
Cyclophosphamide
Thiotepa
Carboplatin - answer Alkylating agents: causes cross-linking DNA strands (non-cell cycle
dependent)
What Class of Chemotherapy? (And MOA)
Cytarabine
Fludarabine - answer Anti-metabolites: Ara-c incorporates into the DNA, makes it non-functional
(ATP)
What Class of Chemotherapy? (And MOA)
Etoposide - answer Topoisomerase II Inhibitors: bind complex of DNA and topoisomerase (coils
and uncoils DNA for replication)- active in G2 phase of cell cycle
, Common Conditioning Regimens: Autologous SCT - answer Myeloma- high dose melphalan
Lymphoma- BEAM
Common Conditioning Regimens: Allogeneic SCT - answer Cy/TBI
Cyclophosphamide and busulfan
Fludarabine and busulfan
Many more options
Types of Preparative Regimens Intensity - answer Nonmeyeloablative (least)
Rediced Intensity (RIC)
Myeloablative (most)
TBI - answer Total Body Irradiation
Myeloablative 12-15 Gy (Fractionated, with >/= 6hr between fractions, less toxic)
RIC 2-8 Gy over 1-4 fractions
Penetrate entire body (including CNS, testes)
Use shields to protect vital organs (heart, lungs, etc)
TRANSPLANT PREPARATIVE
REGIMENS, CELLULAR INFUSION,
ACUTE COMPLICATIONS, AND
ENGRAFTMENT WITH 100% CORRECT
ANSWERS
TRANSPLANT PREP REGIMENS - answer Treatment leading up to transplant
Acronyms:
Ara-C
BCNU
BU
Cy
DLT
SCT
TBI - answer Cytarabine
Carmustine
Busulfan
Cyclophosphamide
Dose limiting toxicity
DStem cell transplant
Total body irradiation
Induction chemotherapy - answer The first treatment given for a disease. It is often part of a
standard set of treatments, such as surgery followed by chemotherapy and radiation. When
used by itself, induction therapy is the one accepted as the best treatment. If it doesn't cure the
,disease or it causes severe side effects, other treatment may be added or used instead. Also
called first-line therapy, primary therapy, and primary treatment.
Consolidation chemotherapy - answer Treatment that is given after cancer has disappeared
following the initial therapy. Consolidation therapy is used to kill any cancer cells that may be
left in the body. It may include radiation therapy, a stem cell transplant, or treatment with drugs
that kill cancer cells. Also called intensification therapy and postremission therapy.
Maintenance chemotherapy - answer Treatment that is given to help keep cancer from coming
back after it has disappeared following the initial therapy. It may include treatment with drugs,
vaccines, or antibodies that kill cancer cells, and it may be given for a long time.
Mobilization chemotherapy - answer Stem cell mobilization: A process in which certain drugs
are used to cause the movement of stem cells from the bone marrow into the blood. The stem
cells can be collected and stored. They may be used later to replace the bone marrow during a
stem cell transplant.
Conditioning (preparative) chemotherapy - answer The treatments used to prepare a patient for
stem cell transplantation (a procedure in which a person receives blood stem cells, which make
any type of blood cell). A conditioning regimen may include chemotherapy, monoclonal
antibody therapy, and radiation to the entire body. It helps make room in the patient's bone
marrow for new blood stem cells to grow, helps prevent the patient's body from rejecting the
transplanted cells, and helps kill any cancer cells that are in the body.
History of SCT and Conditioning - answer Atomic bomb
TBI
1st Transplant 1956, -Dr.
Donnall Thomas
,Cyclophosphamide first chemotherapy to be used for SCT
Goal of Conditioning Regimens - answer Eradicate existing disease (for malignant)
Myeloablation (more for auto)
Immunosuppress recipient to prevent graft rejection
Preserve non-hematologic organs
What Class of Chemotherapy? (And MOA)
Melphalan
Carmustine
Busulfan
Cyclophosphamide
Thiotepa
Carboplatin - answer Alkylating agents: causes cross-linking DNA strands (non-cell cycle
dependent)
What Class of Chemotherapy? (And MOA)
Cytarabine
Fludarabine - answer Anti-metabolites: Ara-c incorporates into the DNA, makes it non-functional
(ATP)
What Class of Chemotherapy? (And MOA)
Etoposide - answer Topoisomerase II Inhibitors: bind complex of DNA and topoisomerase (coils
and uncoils DNA for replication)- active in G2 phase of cell cycle
, Common Conditioning Regimens: Autologous SCT - answer Myeloma- high dose melphalan
Lymphoma- BEAM
Common Conditioning Regimens: Allogeneic SCT - answer Cy/TBI
Cyclophosphamide and busulfan
Fludarabine and busulfan
Many more options
Types of Preparative Regimens Intensity - answer Nonmeyeloablative (least)
Rediced Intensity (RIC)
Myeloablative (most)
TBI - answer Total Body Irradiation
Myeloablative 12-15 Gy (Fractionated, with >/= 6hr between fractions, less toxic)
RIC 2-8 Gy over 1-4 fractions
Penetrate entire body (including CNS, testes)
Use shields to protect vital organs (heart, lungs, etc)
