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BMT CERTIFICATION COURSE||2025-2026|| FULL
SOLUTION PACK WITH 350 ACTUAL QUESTIONS AND
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What does Red Bone marrow do FEEDBACK Produces Hematopoietic Stem cells that create RBC, plt, and WBC found in long and flat bones Think: Red like red blood cells What does Yellow Bone Marrow do? FEEDBACK Both Yellow marrow and fat cells produce stromal stem cells that produce fat, cartilage and bone Think yellow like fat Where are hematopoietic cells produced> FEEDBACK in long bones during childhood and axial skeleton in adulthood What do Myeloid Progenitor cells mature into? FEEDBACK Megakaryocytes (produce plts) erythrocytes --> RBC Mast Cells --> macrophages, myeloid dendritic cell Myeloblasts --.> WBC compoents What do Lymphoid Progenitor cells mature into? FEEDBACKSmall lymphocytes which differentiate into B-cells, T-cells and NK cells
What organs are involved in the immune system? FEEDBACKBone Marrow Thymus (forms T-cells) Lymph Nodes Spleen (filter WBC, plts and other substances) Innate Immunity FEEDBACKuses phagocytes that release inflammatory mediators and NK cells Acquired Immunity FEEDBACKResponse of either B-cells or T-cells Advantages of Syngenic (identical twin) Transplant FEEDBACKNo need for immunosupression Disadvantage to Syngentic Transplant FEEDBACKNo graft vs tumor effect Advantage to matched sibling/related transplant FEEDBACKNo potential stem cell contamination and access to cells Disadvantage to matched sibling/related transplant FEEDBACKOnly 25% of population has a sibling match Risk of GVHD Advantage of mismatched sibling/related transplant FEEDBACKNo potential stem cell contamination and access to cells Increased number of potential donor Disadvantage of mismatched sibling/related transplant\ FEEDBACKIncreased risk of GVHD Increased risk of graft failure d/t HLA disparity Advantage of unrelated donor FEEDBACKNo Potential stem cell contamination
what med is used in conjution with extracorporeal photophoresis Ans✔✔- Methoxsalen (8-methoxypsoralen is used eith ECP) an 8 year old pt who recieved a HSCT develops gradw 2 aGVHD skin rash.. what can the nurse anticipate for inital treatment FEEDBACKTopical steroid cream as it should be used as first line therapy for gradw 1 and 2 skin gvhd which of the following is a non-HLA barrier for transplant research? a) lrg numbers of transplant pts available at each facility b) allele matching of donors to recipients c) heterogenity of RF d) FACT accreditation FEEDBACKC which statement by the nurwse would indicate further teaching about transplant recipients is required? "important criterial used to evaluate a pt for HSCT include" a) support resources available to the patient b) current disease status c) age of caregiver d) baseline organ fx FEEDBACKC grapefruit juice should be avoided when taking which med and why? FEEDBACKTac ro .. it can increase the levels prior to starting treatment for engraftment syndrome what is the priority nursing action? a) obtain order for IV fluids b) ensure the infectious disease workup is complete c) place the patient in protective isolation for 14 days d) d/c GCSF FEEDBACKB
which of the following is a characteristic of stromal cells? FEEDBACKStromal cells are the primary location of hematopoiesis two hours after HSCT infusion a patient calls the nurse to report red urine. What is the most likely cause? A) breakdown of RBC in the product B) low PLT count C) hemorrhagic cystitis D) meds given prior to transplant FEEDBACKA following an allo transplant, a patient arrives at clinic reporting weakness and fatigue that has worsened over the past week. Which nursing intervention would be the most appropriate? A) get an order to trasnfuse a unit of PRBC B) suggest the patient take long naps during the day C) encourage the patient to incorporate regular aerobic and resistance exercises D) request a refferal to skilled nursing facility FEEDBACKC The caregiver of a patient at a clinic visit reports witnessing unusual behaviour, sleep problems and sadness. The nurse believes the patient may be exhibiting signs of A) PTSD B) BPD C) Posterior reversible encephalopathy syndrome D) Tacro Toxicity FEEDBACKA 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
Melanoma Lung CA Common Hematologic Malignancies treated with Autos FEEDBACKHodgkins disease NHL MM Common Hematologic Malignancies treated with allos FEEDBACKAML ALL CML MDS NHL? Juvenile Myelomonocytic Leuk hematologic non-malignant disease treated with allos FEEDBACK SAA Fanconi Anelia Thalassemia Diamon-Blackfan Anemia Chediak-Higashi Syndrome Chronic Granulomatous Disease Congenital Neutropenia Common Immunodeficiencies treated with Allos FEEDBACKSevere Combined immunodeficiency disease Wiskott-Aldrich Syndrome Functional T-cell deficiency Common genetic diseases treated with allos FEEDBACKAdrenoleukodystro phy Metachromatic leukodystrophy hurler syndrome
Hunter Disease Gaucher Syndrome Miscellaneous diseases treated with allos FEEDBACKosteopor osis langerhans cell histiocytosis glycogen storage disease what is the goal of therapy for malignant disease FEEDBACKtumor ablation what is the goal of therapy for nonmalignant disease FEEDBACKcell line replacement (eg AA, sickle-cell dx,chronic granulomas) Graft vs. tumor efect FEEDBACKPromoted by withdrawl of immunosuppressant therapy promoted by DLI Decreased in the absence of aGVHD Associated with higher rates of CA relapse Immune Reconstitution FEEDBACKDependant on patients hematologic response to preperative regimen Dependent on the rate of engraftment Dependent on survival and longevity of mature lymphocytes present at the time of transplant Delayed in patients with Chronic GVHD May take months to years Advantages of PBSC FEEDBACKEngraftment 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
limited use b/c of the number of stem cells in any given unit slower engraftment of BM or PSCT Delayed post transplant immune reconsitiution Decreased GVT effect Increased Risk of graft failure impossible to get more donor cells if needed cost Patients require an EF of what before getting a transplant? FEEDBACK50% (ideally) what are HLA's? FEEDBACKhuman leukocyte antigens - glycoproteins that reside on the suface of cells (located on chromosome 6) what do HLA's do FEEDBACKProduce immune cells that destroy antigens What makes an optimal domor FEEDBACKyoung male with heavier weight in the case of female ... young and heavy and no prior pregnancies how long prior to collection of stem cells should infectious disease testing be done? FEEDBACK 30 days prior to collection what is the success of a sct measured by? FEEDBACKCD34 cells obtained what are the main classes of drugs used to mobalize stem cells into the peripheral blood? FEEDBACKGrowth Factors Chemotherapy (cyclophos) and Chemokine antagonists (plerixafor) GCSF FEEDBACKStimulates production of hematopoietic cells by binding to certain cell receptors
How many injections of GCSF are needed before stem cell collection? FEEDBACK 4 - 5 days Common side effects of GCSF FEEDBACKbone pain, HA, fatigue, muscle aches, N+V, stomach pain what are common chmo agens used to mobalization of stem celss FEEDBA CKcyclophos etoposide cytarabine paclitaxel how does chemo work in mobalizing stem cells FEEDBACKcauses a reduction in the production of blood cells, which stimulates hematopoietic recovery Plerixafor is used for mobalization of stem cells in what patients? FEEDBACKNHL and MM when should plerixafor be given prior to mobalization? FEEDBACK11 hours before first apheresis procedure common side effects of plerixafor? FEEDBACKLeukocytosis, thrombocytopenia, nausea, redness at injection sitem dizziness, diarrhea and fatigue what are some common symptoms of leukopheresis and why? FEEDBACKS+S associated with hypocalcemia due to sodium citrate to prevent blood from clotting fatigue chills tingling in the lips and extremeties and dizziness other symptoms include:
what is the primary conditioning regiem for relapsed or refractory germ cell tumors? FEEDBACKCarboplatin, ifosfamide and etoposide (or w/o ifosfamide) What are some conditioning regims for lymphomas and AML FEEDBACKBEAM; TBI, cyclophos, and etoposide; thiotepa, bu and mel; cyclophos, carmustine and etoposide; bu+cy conditioning regimen for AA FEEDBACKCyclophos and ATG (+/- TBI) Nonmyeloblatic RIC regimes FEEDBACKTBI + Flu; Flu+Cy; BU, FLU *can be used for all dx What myeloblatic regimes are used for pts with leukemia, MDS or lymphoma requiring an Allo FEEDBACKTBI and etop; cy+tbi; FLU+BU dosing for myeloblative TBI FEEDBACKbetween 12 - 15Gy over 8 - 12 fractions for 3 - 4 days dosing for RIC TBI FEEDBACKbetween 2 - 8gy over 1 - 4 fractions for single or multiple days GI side effects of TBI FEEDBACK N+V Gastroenteritis mucositis deratitis fatigue Pulmonary side effects of TBI FEEDBACKPneumotho rax Pulm infection idiopathic pneumonia syndrome hemorrhage edema
Long term side effects of TBI FEEDBACKsterility cataracts growth failure thyroid dysfxn gonadal failure renal dysfxn What should patients getting TBI avoid? FEEDBACKlotions, creams, deoderants or any topical med becuase they can increase skin injury ATG FEEDBACKimmunosuppressive agrent that inhibits thymus dependant human T- cells and other immune cells involved in cellular immunity Goal of ATG in allo transplant FEEDBACKUsed to deplete residual host T-cell and reduce the effective dose of infused T cells with the graft Acute side effects of ATG FEEDBACKFev ers chills hypoT Fluid overload and third spacing Life threatening side effects of ATG FEEDBACKPulmonary edema Pre-renal azotemia hepatic dysfxn serum sickness skin rash join pain that impedes mobility Carmustine requires what before and after infusion FEEDBACKHydration What are some acute side effects of BCNU? FEEDBACKN+V and reversable hepatic dysfxn
what premed does caboplatin require? FEEDBACKantiemetic Longterm complications of carboplatin?? FEEDBACKnon-reversable ototoxicity neurotoxicity (eg peripheral neuropathy) What are some acute SE of carboplatin? FEEDBACKlyte imbalances hypernatremia renal insufficiency acidosis delayed N+V What electrolyte imbalance can we see with carboplatin? FEEDBACKHYPERnatremia what type of chemotherapy is cyclophos? FEEDBACKAlkylating agent What are some acute side effects of Cyclophos FEEDBACK1) Histamine Rxn - > premed with emetogenic (dex) and sometimes bene
- Cardiac complications (get baseline ECG)
- Cardiomyopathy
- hemorrhagic myocardial necrosis
- coronary artery vasculitis
- Hemorrhagic Cystitis
- Hydrate and administer MESNA
- Endocrine (SIADH)
- N+V+D
- Skin
- alopecia
- hyperpigmentation
- ridging of nails
- Pulmonary
- rare pneumonitis
- fibrisis (tx includes corticosteroids)
What are some acute GU effects of cyclophos FEEDBACKhemorrhagic cystitis How do we prevent hemorrhagic cystitis with cyclophos? FEEDBACKIncrease fluids and admin of mesna to decreease risk What acute endocrine effect can happen when on cyclophos? FEEDBACKSIADH --> results in HYPOnatremia and possibly seizures How is cytarabine metabolized and excreted FEEDBACKmetabloized through the liver and excreted by the kidneys What are some acute SE of cytarabine FEEDBACKmucos itis ataxia nystagmus chemical conjunctivitis (with high dose) slurred speach and gait changes (d/t cerebellar dysfxn) generalized dermititis biliary stasis elevated liver functinon tests fever myalgia bone pain chest pain capillarly leak syndrome What kind of chemo is etoposide? FEEDBACKplant alkaloid that inhibits type 2 topoisomerase where is etoposide extreted FEEDBACKurine and bile
mucositis FEEDBACKcryotherapy (suck on ice chips) for at least 30 min post infusion to decrease blood flow to oral mucosa What longterm complication is associated with melphelan FEEDBACKIntersti tial pneumonititis and fibrosis (reversible with corticosteroids) what kind of drug is thiotepa FEEDBACKalylating agent how is thiotepa metabolized and excreted? FEEDBACKmetabolized via liver and excreted via sweat and urine Acute side effects of thiotepa FEEDBACKmental status decline with CNS changes HA mucositis skin desquamation elevated liver enzymes long term complications of thiotepa FEEDBACK SOS pulmonary toxicities what does using cyclophosphomise post transplant do FEEDBACKsupresses T- cell activity to prevent graft failure TBI and children FEEDBACKshould be avoided in smaller children and NEVER given to children under the age of 2 what is SAA FEEDBACKa disease in which an autoimmune reaction occurs leaving the bone marrow empty and unable t produce normal immune cells Qhat is SCID? FEEDBACKsevere combinded immunodeficiency and is a deficiency of the lyphoid immune system
what is the unique goal of transplants in SCID FEEDBACKfocusing on the chimerism of lymphocytes Fanconi Anemia (FA) FEEDBACKa genetic disorder associated with progressive bone marrow failure , increasing risk for leuk and other Ca What kind of conditioning regime is used for FA FEEDBACKRIC at what temp are cryoperserved cells thawed FEEDBACK 37 degrees celcius or 98.6 degrees F Acceptable dosing for DMSO FEEDBACK1mg/kg/day Symptoms of DMSO toxicity FEEDBACKAbdo cramps bradycardia chest tightness dysrhythmias fever flushing HTN or HypoT nausea SOB Tachycardia Garlic like odor vomiting wheezing acute hemolytic reaction (AKA abo incompatibility) S+S FEEDBACKcheck and back pain fever
