Deck 29: Hematopoietic Stem Cell Transplantation

Question 1

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

Answer 1

HLA alloantigens and an immunosuppressed host

Question 2

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

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

Answer 2

Hematology

Question 3

Autologous stem cell transplant is commonly used as treatment for:

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

Answer 3

Hodgkin lymphoma

Question 4

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

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

Question 5

One disadvantage 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 6

How HSCs differ from committed progenitor cells in that HSC has:

A)Ability to self-renew
B)Success in autologous transplantation
C)Potency in the immune response
D)Location of maturation

Question 7

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

A)Cadaver cells are not suitable because of the patient's cytokine treatment.
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 8

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 9

The laboratory professional is not involved in which of following steps associated with SCT?

A)Compatibility testing
B)Pretransfusion testing
C)Apheresis
D)Transfusion of SCT product in patient

Question 10

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

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

Question 11

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 12

Which of the following 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 13

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

Question 14

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

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

Question 15

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

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)Complications are associated with the collection.
D)The number of stem cells is usually insufficient for an adult transplant.

Question 17

Which of the following type of SCT patients has the highest risk of developing GVHD?

A)Syngeneic transplant patients
B)Autologous transplant patients
C)Allogeneic transplant patients
D)Isogeneic transplant patients

Question 18

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 19

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 20

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)Total number of stem cells for adult is reduced in transplant patients .
C)Cord blood contains sufficient numbers but is not compatible within ethnic groups.
D)The risk of viral contamination is low.

Question 21

Following apheresis of a patient for an autologous stem cell transplant,the laboratician:

A)Freezes the cells in bags with DMSO
B)Performs WBC,mononuclear cell,and CD34 cell count
C)Purges the sample of all T8 cells
D)Performs chimerism studies

Question 22

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

Question 23

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

Question 24

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

A)Patient diagnosis
B)Patient age
C)Patient sex
D)Patient weight

Question 25

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 26

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 27

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

Question 28

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)Bone marrow exam for stem cells

Question 29

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

Question 30

When calculating the dose of stem cells needed for the recipient,what factor per kilogram of recipient weight must be considered?

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

Question 31

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

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

Question 32

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)Purge of CD8 lymphocytes
D)Apheresis

Question 33

An early complication of a stem cell transplant includes:

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

Question 34

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 35

A 64-year-old patient received an SCT in March.Two weeks after the transplant,the physician ordered a routine blood count.The patient's ANC is 12 ×10⁹/L,and his platelet count is 65 × 10⁹/L.Chimerism studies were performed 6 months after his transplant using VNTR polymorphisms,which indicated a partial chimerism.Interpret these results regarding what they 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 long-term results are indeterminate.
D)The patient did not achieve engraftment at all.

Question 36

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 37

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

Question 38

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,platelet count,and chimerism studies

Question 39

Cord blood is a source of stem cells but must meet certain requirements before being collected.Which of the following is a factor 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 40

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

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

Question 41

Explain the detection and significance of chimerisms in stem cell transplantation.