Deck 26: Hematopoietic Stem Cell Transplantation

Question 1

The advantages of using cord blood stem cells as the source of HSC are numerous.What can be seen as one of the drawbacks when used in the adult population?

A)The GVL effect is increased.
B)Reduction of total number of stem cells for adult transplant patients
C)Cord blood contains sufficient numbers, but is not compatible within ethnic groups.
D)The risk of viral contamination is low.

Answer 1

Reduction of total number of stem cells for adult transplant patients

Question 2

Which of the following best represents the correct order of maturation (youngest to most mature) for hematopoiesis?

A)HSC > precursor >committed progenitor
B)Precursor >HSC >committed progenitor
C)HSC > committed progenitor > precursor
D)Committed progenitor >precursor > HSC

Answer 2

HSC > committed progenitor > precursor

Question 3

Which of the following disorders can be treated by stem cell transplantation?

A)Leukemia
B)Aplastic anemia
C)Sickle-cell disease
D)All of the above

Answer 3

All of the above

Question 4

What is the single most important factor considered in donor selection for an allogeneic transplant?

A)HLA compatibility with the patient
B)ABO compatibility with the patient
C)CMV status of the donor
D)HLA and ABO compatibility with the recipient

Question 5

Which of the following is correct regarding allogeneic stem cell transplant and ABO antigens?

A)ABO antigens do not need to be matched.
B)ABO antigens are strongly expressed on stem cells.
C)The O group patient should not receive stem cells from A or B blood group donors.
D)ABO antigens should always be matched between donor and recipient.

Question 6

Stem cells can treat a variety of different disorders due to their ability to:

A)Self-renew.
B)Give rise to other cells.
C)Regenerate quickly.
D)Possess immunity against toxic agents.

Question 7

Which of the following diseases can be treated with an allogeneic transplant?

A)Hodgkin's lymphoma
B)Solid organ tumors
C)Non-Hodgkin's lymphoma
D)Acute leukemia

Question 8

One of the disadvantages of using autologous stem cells for treatment in a leukemia patient is:

A)The graft-versus-leukemia effect is not possible.
B)There is increased risk for graft-versus-host disease.
C)There is not a need for immunosuppression.
D)The yield of stem cells is low.

Question 9

What is the main reason for using an allogeneic stem cell transplant?

A)Cadaver cells are not suitable due to cytokine treatment of the patient.
B)Adequate numbers are achieved with this type of transplantation.
C)Highly incompatible tissues are found with the other types of transplantation.
D)The disease process involves the patient's own stem cells preventing autologous transplant.

Question 10

Autologous stem cell transplant is commonly used as treatment for:

A)Hodgkin lymphoma.
B)Acute myelogenous leukemia.
C)Inherited diseases.
D)Aplastic anemia.

Question 11

A major limitation of using cord blood for stem cell transplants is:

A)Number of stem cells is inadequate for most adults.
B)Collecting cord blood is dangerous for the baby.
C)The risk of bacterial contamination is great.
D)It does not contain CD4 lymphocytes.

Question 12

Which of the following types of SCT patients have the highest risk of developing GVHD?

A)Syngeneic transplant patients
B)Autologous transplant patients
C)Allogeneic transplant patients Correct

Question 13

Which of the following infections can be life-threatening in a SCT patient during the peritransplant period?

A)Bacterial
B)Fungal
C)Viral
D)All of the above

Question 14

The most important antigens that need to be matched for a successful outcome in stem cell transplants are:

A)ABO.
B)Rh.
C)HLA.
D)Ii.

Question 15

An optimum result of HLA compatibility is based on which of the following matches between the donor and recipient?

A)Class I and class II antigens
B)HLA-A and HLA-B antigens
C)HLA-DR, HLA-DP, and HLA-DQ
D)HLA-A, HLA-B, and HLA-DR

Question 16

How are HSCs different from committed progenitor cells?

A)Their ability to self-renew
B)Their success in autologous transplantation
C)Their potency in the immune response
D)Their location of maturation

Question 17

Graft-versus-host disease results from which of the following?

A)Donor T cells initiating an immune response against host recipient cells
B)Secondary CMV infection
C)Recipient T cells initiating an immune response against donor cells
D)Tumor infiltration in MALT tissue

Question 18

This antigen can be used to identify stem cells by immunophenotyping:

A)CD34.
B)CD4.
C)CD8.
D)CD33.

Question 19

Which of the following infectious agents has the ability to re-emerge in SCT patients on multiple occasions?

A)Streptococcus infection
B)Cytomegalovirus infection
C)Candidiasis
D)Epstein-Barr virus infection

Question 20

Graft-versus-host disease must have three factors.The first is the presence of immunocompetent donor T lymphocytes.What are the remaining two factors?

A)Degree of marrow involvement and age of patient
B)Response to previous chemotherapy and underlying disease
C)HLA alloantigens and an immunosuppressed host
D)Donor availability and degree of marrow involvement

Question 21

When the decision is made to undertake the stem cell transplantation process, many laboratories are involved in working for a successful outcome.The MNCs product will go to which laboratories for cell counts and immunotyping?

A)Molecular diagnostic and HLA labs
B)Hematology and flow cytometry labs
C)Blood bank and HLA labs
D)Molecular diagnostics and hematology labs

Question 22

An early complication of a stem cell transplant includes:

A)Hypogonadism
B)Development of secondary leukemia
C)Graft-versus-host disease
D)Neuropathies

Question 23

The laboratory professional is involved in which of following steps associated with SCT?

A)Compatibility testing
B)Pretransfusion testing
C)Apheresis
D)All of the above

Question 24

Which of the following occurs prior to infusion of stem cells into the recipient?

A)Blood count for ANC
B)Chimerism studies
C)GM-CSF infusion
D)CD34 enumeration

Question 25

A procedure used to decrease the potential for GVHD in an allogeneic transplant is:

A)Freeze thaw to kill lymphocytes.
B)Activation of CD4 cells and suppression of CD8 cells.
C)Purging of CD8 lymphocytes.
D)Apheresis.

Question 26

Interpret the results below.A 64-year-old patient received a SCT in March.Two weeks after the transplant, the physician ordered a routine blood count.The patient's ANC is 12 x109/L and his platelet count is 65 x 109/L.Chimerism studies were performed six months after his transplant using VNTR polymorphisms, which indicated a partial chimerism.What does this mean for the patient?

A)The patient achieved short-term and long-term engraftment.
B)The patient achieved long-term engraftment, but not short-term engraftment.
C)The patient achieved short-term engraftment, but results are indeterminate in the long term.
D)The patient did not achieve engraftment at all.

Question 27

Explain the significance of HLA and ABO antigen compatibility in stem cell transplantation.

Question 28

Which type of transplant does not have a risk of developing GVHD?

A)Autologous transplant
B)Allogeneic transplant
C)Syngeneic transplant Correct

Question 29

Engraftment after transplant is determined by short-term evidence of hematopoietic proliferation.What are the peripheral blood absolute cell counts that indicate short-term engraftment?

A)Absolute neutrophil count is more than 100 µL and platelet count is more than 50,000 µL.
B)Absolute lymphocyte count is less than 500 µL and platelet count is more than 10,000 µL.
C)Neutrophil count is more than 500 µL and the platelet count is more than 20,000 µL.
D)Neutrophil count is more than 1000 µL and the platelet count is more than 10,000 µL.

Question 30

Which of the following best represents the proper order for drug regimen for a SCT patient?

A)Chemotherapy >antihistamine and antiemetic > GM-CSF
B)Antihistamine and antiemetic > GM-CSF > chemotherapy
C)Chemotherapy > GM-CSF > antihistamine and antiemetic
D)GM-CSF > antihistamine and antiemetic > chemotherapy

Question 31

When calculating the dose of stem cells needed for the recipient, what factors must be considered?

A)When using umbilical cord blood, a minimum of 3.0 x 105 of total nucleated cells per kilogram recipient weight
B)Cell doses of a minimum of 2.5-5.0 x 106 CD34+ cells per kilogram recipient weight
C)Cell doses of a minimum of 0.5-1.5 x 103 CD56+ cells per kilogram recipient weight
D)When using umbilical cord blood, a minimum of 1.0 x 103 of total nucleated cells per kilogram recipient weight.

Question 32

Following a stem cell transplant, what steps are identified in the evaluation of engraftment of stem cells?

A)Chimerism studies, bone marrow M:E ratio and cellularity
B)CD34 enumeration of peripheral blood and bone marrow cellularity
C)Absolute lymphocyte count, chimerism studies and bone marrow cellularity
D)Absolute neutrophil count enumeration, and platelet count and chimerism studies

Question 33

Which laboratory department is responsible for performing testing to verify short-term engraftment?

A)Hematology
B)Molecular/HLA
C)Microbiology
D)Immunology

Question 34

Which of the following laboratory tests is used to assess long-term engraftment?

A)Automated complete blood count
B)Chimerism
C)CD34 count by flow
D)Manual WBC count

Question 35

Which of the following determines the number of stem cells needed for a transplant procedure?

A)Diagnosis of the patient
B)Patient age
C)Patient sex
D)The weight of the patient

Question 36

Which HSC quantitation method would be optimal for verification of late-stage engraftment?

A)Manual count of MNCs
B)CD34 enumeration by flow cytometry
C)Cell culture for CFUs
D)All of the above

Question 37

Which of the following are used to quantitate the number of hematopoietic stem cells collected?

A)CD34 quantitation by immunophenotyping
B)Chimerism studies by immunophenotyping
C)Ratio of neutrophils to lymphocytes
D)Cytochemical studies

Question 38

What is a primary disadvantage of transfusing umbilical cord blood as a source of HSCs?

A)The risk of viral infection is high.
B)It needs to be frozen soon after collection.
C)There are complications associated with the collection.
D)The number of stem cells is usually insufficient for an adult transplant.

Question 39

Following apheresis of a patient for an autologous stem cell transplant, the laboratory professional will:

A)Freeze the cells in bags with DMSO.
B)Perform WBC, mononuclear cell,and CD34 cell count.
C)Purge the sample of all T8 cells.
D)Perform chimerism studies.

Question 40

Cord blood is a source of stem cells, but must meet certain requirements before being collected.Which of the following are factors that might lead to not collecting the cord blood?

A)More than 50 mL being available
B)Nine month gestation
C)Rh negative baby
D)Family history of inherited diseases

Question 41

Explain the role of the clinical laboratory professional in stem cell transplantation.

Question 42

Explain graft-versus-leukemia process in stem cell transplantation.

Question 43

Compare and contrast the collection of umbilical cord stem cells for transplantation and that of allogeneic stem cells for transplantation.