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BMT CERTIFICATION COURSE QUESTIONS AND ANSWERS
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BMT CERTIFICATION COURSE QUESTIONS AND ANSWERS
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BMT CERTIFICATION COURSEQUESTIONS AND ANSWERS
a 45 year old female with AML arrives for her pre-transplant eval. The pts twin sister
offers to donate but the MD opts to use a donor from the antional marrow donor
program because:
A) cost of immunosuppression meds is high
B) the MD prefers to use the National Marrow Donor Program
C) syngenic transplants increase the risk of tumor relapse
D) the patients sister is also identified as her caregiver - ANSWER-C .. due to no graft
vs tumor effect
a higher risk of infection is present in donors who are? - ANSWER-HLA mismatched..
particularly haplos
A patient who is diagnosed with acute myeloid leukemia two years after treatment for
neuroblastoma is being evaluated for an allogeneic HSCT. Which medication most likely
contributed to the secondary malignancy - ANSWER-Topoisomerase II inhibitor-related
AML usually appears 2-3 years after exposure to the drug. Etoposide is a
topoisomerase II inhibitor.
Acceptable dosing for DMSO - ANSWER-1mg/kg/day
Acquired Immunity - ANSWER-Response of either B-cells or T-cells
acute hemolytic reaction (AKA abo incompatibility) S+S - ANSWER-check and back
pain
fever
chills
dyspnea
shock
abdo bleeding
DIC
acute SE of busulfan - ANSWER-N+V+D
stomatitis
hepatitis
alopecia (can be permanent)
hyperpigmentation
rash
anorexia
SOS
,Acute side effects of ATG - ANSWER-Fevers
chills
hypoT
Fluid overload and third spacing
Acute side effects of ifosfamide - ANSWER-N+V
Alopecia
metabolic acidosis
encephalopathy
hemorrhagic cystitis
pulmonary toxicities
Acute side effects of thiotepa - ANSWER-mental status decline with CNS changes
HA
mucositis
skin desquamation
elevated liver enzymes
Advantage of mismatched sibling/related transplant - ANSWER-No potential stem cell
contamination and access to cells
Increased number of potential donor
Advantage of mismatched unrelated Donor - ANSWER-No Potential stem cell
contamination
Advantage of UCB - ANSWER-ease of access to cord blood units
short time from selection of cord blood unit until available for use
simple collection process - no harm to mom or bb
lower risk of GVHD
Decrease risk of viral disease transmission
Advantage of unrelated donor - ANSWER-No Potential stem cell contamination
Advantage to matched sibling/related transplant - ANSWER-No potential stem cell
contamination and access to cells
Advantages of Bone Marrow transplant - ANSWER-harvest can be completed in a few
hours
gnerally well tolerated and is an outpatient proceedure
decreased risk of GVHD in allo setting
Advantages of PBSC - ANSWER-Engraftment of neuts and plts typically faster
can be done in outpatient setting
collection is well tolerated
early regimen related toxicity in allo setting is decreased
hospital stay decreased d/t faster engraftment
,an increased immunologic function is evident comapred to BM
no anesthesia needed for donor
Advantages of Syngenic (identical twin) Transplant - ANSWER-No need for
immunosupression
Advantages of Umbilical cord blood transplant - ANSWER-Easy access to cell source
alefacept can be used as second line therapy for cgvhd which patients respond best to
this treatment? - ANSWER-skin, mucosa, vagina and lung
an 8 year old pt who recieved a HSCT develops gradw 2 aGVHD skin rash.. what can
the nurse anticipate for inital treatment - ANSWER-Topical steroid cream as it should be
used as first line therapy for gradw 1 and 2 skin gvhd
at what point can HSCT patients get the Dipgtheria, tetanus and pertussis (DTaP)
vaccine? - ANSWER-suggested at 9,12 and 18 months however it can be given at 6
months
at what point can HSCT patients get the haemophilus influenzae type B (HIB) vaccine?
- ANSWER-suggested at 9,12 and 18 months however it can be given at 6 months
at what point can HSCT patients get the hepatitis B vaccine? - ANSWER-may get it at
12,14,and 18 months post transplant. Suggested in HBV (-) patients
at what point can HSCT patients get the influenza vaccine? - ANSWER-may administer
at 4 months post transplant, however 2 doses are recommended
at what point can HSCT patients get the Measles, mumps, and rubella MMR vaccine? -
ANSWER-at 24 months or 2 years post transplant, if not immunocompromised
at what point can HSCT patients get the meningococcus vaccine? - ANSWER-may get
1 dose after 6 months post trasnplant
at what point can HSCT patients get the pneymococcal (PCV7/PPSV23) vaccine? -
ANSWER-suggested at 9,12 and 18 months however it can be given at 6 months
At what point can HSCT patients get the shingles vaccine? - ANSWER-at 24 months or
2 years post transplant, if not immunocompromised
at what temp are cryoperserved cells thawed - ANSWER-37 degrees celcius or 98.6
degrees F
ATG - ANSWER-immunosuppressive agrent that inhibits thymus dependant human T-
cells and other immune cells involved in cellular immunity
, Bone Marrow Transplants still happen today.. who are they typically used for? -
ANSWER-People who do not require graft vs. tumor effect (ie AA, sickle cell anemia)
and pediatric donors
Can BCNU cross the BBB - ANSWER-YES! lipid soluble
Carmustine requires what before and after infusion - ANSWER-Hydration
cataracts may develop in the LBMT setting as a result of waht? - ANSWER-prolonged
steroid use and TBI
cGVHD can affects the nails in which ways? - ANSWER-dystrophy characterized by
longitudinal ridging, nail splitting or brittleness, onycholysis and nail loss
Chronic graft-versus-host disease that develops without clinical evidence of previous
acute graft-versus-host disease is referred to as - ANSWER-De novo
Classic Chronic GVHD - ANSWER-Manifestations of autoimmune disease and no
features characteristic of aGVHD
It is a syndrome that involves multiple organs including the eyes, skin, oral mucosa,
lung, GI tract and liver
clinical charateristics of hepatic GVHD - ANSWER-hyperbili
increased alk phos
elevated transaminases (ALT and AST)
CNI's carry a high risk of developing what? - ANSWER-Transplant associated
thrombotic microangiopathy (TA-TMA)
Common genetic diseases treated with allos - ANSWER-Adrenoleukodystrophy
Metachromatic leukodystrophy
hurler syndrome
Hunter Disease
Gaucher Syndrome
Common Hematologic Malignancies treated with allos - ANSWER-AML
ALL
CML
MDS
NHL?
Juvenile Myelomonocytic Leuk
Common Hematologic Malignancies treated with Autos - ANSWER-Hodgkins disease
NHL
MM
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