Hematopoietic Stem Cell Transplantation — MCQs
Which of the following methods can be used to prevent graft-versus-host disease in bone marrow transplantation?
HLA typing is useful in:
Stem cells are typically harvested from all except which?
After 4 months of renal transplantation, a patient is likely to develop which infection?
A 44-year-old female presented to OPD with complaints of pallor, fatigue, weakness, palpitations and dyspnea on exeion. Blood tests were conducted, which revealed, Anemia Thrombocytopenia Leukocytosis with neutropenia and increased blasts in the peripheral blood smear. Peripheral blood smear The patient was diagnosed with leukemia and she underwent allogenic stem cell transplantation for the same. After 24 days, she again presented with hypotension, tachycardia, and spO2 of 88% along with a new rash from which biopsy was taken and silver staining was done. Lab findings revealed severe Neutropenia. Which is the most likely organism causing the above skin condition: -
All of the following are good prognostic factors for pediatric acute lymphoblastic leukemia, except:
Which of the following is the platinum-based chemotherapeutic agent used as first-line treatment for ovarian carcinoma?
Choose the correct option regarding graft rejection.
Most common complication after intestinal transplantation is
The Hematopoietic syndrome results when acute whole-body radiation exposure is above:
Hematopoietic Stem Cell Transplantation Indian Medical PG Practice Questions and MCQs
Question 1: Which of the following methods can be used to prevent graft-versus-host disease in bone marrow transplantation?
- A. T-cell removal
- B. Post procedure immune suppression
- C. Prior immune suppression
- D. All of the options (Correct Answer)
Explanation: ***All of the options*** - **T-cell removal** from the donor marrow significantly reduces the number of alloreactive T-cells that can cause GVHD. - **Prior immunosuppression** prepares the recipient's immune system to reduce graft rejection, while **post-procedure immunosuppression** helps manage any remaining alloreactive cells [1]. *T-cell removal* - This method directly targets the cells primarily responsible for initiating **graft-versus-host disease (GVHD)**. - While effective, it can also increase the risk of **graft failure** and **leukemic relapse** due to the loss of graft-versus-leukemia effects. *Post procedure immune suppression* - Administering **immunosuppressive drugs** after transplantation helps to suppress the recipient's immune response and prevent donor immune cells from attacking recipient tissues [1]. - Common regimens include **cyclosporine**, **methotrexate**, or **tacrolimus**, which are tapered over time to minimize side effects [2, 3]. *Prior immune suppression* - Suppressing the **recipient's immune system** before transplantation helps to create an environment where the donor cells are less likely to be rejected and reduces recipient T-cell mediated responses against the graft [1]. - This is typically part of the **conditioning regimen** given before the bone marrow infusion.
Question 2: HLA typing is useful in:
- A. Disputed paternity
- B. Dactylography
- C. Organ transplant (Correct Answer)
- D. Thanatology
Explanation: ***Organ transplant*** - **HLA typing** is crucial for **matching donors and recipients** in organ transplantation to minimize the risk of transplant rejection [1]. - A better **HLA match** between donor and recipient reduces the likelihood of the recipient's immune system attacking the transplanted organ [1]. *Disputed paternity* - While **HLA typing** was historically used, **DNA fingerprinting** (using STR markers) is now the primary and more accurate method for determining paternity [2]. - **DNA analysis** provides a higher probability of inclusion or exclusion and is less complex to interpret than HLA typing for paternity [2]. *Dactylography* - **Dactylography** refers to the study of fingerprints for **identification purposes**, a field entirely unrelated to genetic markers. - It involves analyzing the unique patterns of **ridges and valleys** on fingertips, not genetic typing. *Thanatology* - **Thanatology** is the scientific study of **death and dying**, including the psychological, social, and cultural aspects. - It does not involve genetic testing like **HLA typing** but rather focuses on end-of-life care, grief, and the processes surrounding death.
Question 3: Stem cells are typically harvested from all except which?
- A. Liver (Correct Answer)
- B. Bone marrow
- C. Blood
- D. Adipose tissue
Explanation: ***Liver*** - **Liver** is not a recognized source of **pluripotent stem cells**, as it primarily contains specialized cells for hepatic functions. - While some **liver stem cells** exist, they are not generally sourced for therapies compared to other tissues like **bone marrow or adipose tissue** [1]. [2] *Adipose tissue* - **Adipose tissue** is a known source of **adipose-derived stem cells (ADSCs)**, which have regenerative potential [1]. - It is frequently used for **cosmetic and reconstructive applications** due to its ease of harvesting [1]. *Blood* - **Blood** contains **hematopoietic stem cells (HSCs)** primarily in the bone marrow, which can be harvested from peripheral blood after mobilization. - These stem cells are essential for **blood cell formation** and are effective in treatments for blood disorders [2]. *Bone marrow* - **Bone marrow** is a primary source of **hematopoietic stem cells**, crucial for **blood and immune system regeneration** [1]. [2] - It is commonly harvested for **transplants in conditions like leukemia** [2].
Question 4: After 4 months of renal transplantation, a patient is likely to develop which infection?
- A. EBV
- B. CMV (Correct Answer)
- C. Candida
- D. Histoplasma
Explanation: ***CMV*** - **Cytomegalovirus (CMV)** infection is very common in solid organ transplant recipients, particularly in the period between **1 to 6 months post-transplant**, known as the **intermediate period** [1]. - This timing is due to the cumulative effect of **immunosuppression** compromising the patient's ability to control latent viral shedding or newly acquired infection. *EBV* - **Epstein-Barr virus (EBV)** infection is also common in transplant recipients, but it is more significantly associated with the development of **post-transplant lymphoproliferative disorder (PTLD)**, rather than being the *most likely* general infection at 4 months [2], [3]. - While EBV can occur, CMV is typically more prevalent as a symptomatic viral infection in the intermediate post-transplant period [1]. *Candida* - **Candida** infections (fungal) are more common in the **early post-transplant period** (within the first month), often associated with surgical complications, indwelling catheters, or broad-spectrum antibiotic use [1]. - While possible, it is less likely to be the *most common* infection at 4 months compared to CMV. *Histoplasma* - **Histoplasma** infections are a **systemic fungal infection** that is typically seen in transplant patients who have been exposed to endemic areas. - It is not a common opportunistic infection universally seen in transplant recipients at 4 months post-transplant but rather depends on geographical exposure and specific risk factors.
Question 5: A 44-year-old female presented to OPD with complaints of pallor, fatigue, weakness, palpitations and dyspnea on exeion. Blood tests were conducted, which revealed, Anemia Thrombocytopenia Leukocytosis with neutropenia and increased blasts in the peripheral blood smear. Peripheral blood smear The patient was diagnosed with leukemia and she underwent allogenic stem cell transplantation for the same. After 24 days, she again presented with hypotension, tachycardia, and spO2 of 88% along with a new rash from which biopsy was taken and silver staining was done. Lab findings revealed severe Neutropenia. Which is the most likely organism causing the above skin condition: -
- A. Neisseria meningitidis
- B. Pseudomonas (Correct Answer)
- C. Staphylococcus aureus
- D. Vibrio vulnificus
Explanation: ***Pseudomonas*** - The clinical presentation of **neutropenia**, fever, and a rapidly progressive skin rash after stem cell transplantation is highly suggestive of **ecthyma gangrenosum**, a severe cutaneous infection typically caused by *Pseudomonas aeruginosa*. - **Silver staining** in a biopsy would highlight bacteria, and *Pseudomonas* is a common cause of severe infections in immunocompromised patients, especially those with **neutropenia**. *Neisseria meningitidis* - While *Neisseria meningitidis* can cause rash (e.g., **petechial or purpuric rash** in meningitis), it is less likely to present as a focal, rapidly necrotic skin lesion like ecthyma gangrenosum, especially in the context of profound neutropenia post-transplant without overt signs of meningococcal disease. - The rash associated with meningococcemia is typically due to **vasculitis and thrombosis**, not direct bacterial colonization leading to necrotic lesions in the same way *Pseudomonas* does. *Staphylococcus aureus* - *Staphylococcus aureus* can cause various skin infections, including **cellulitis, abscesses, or impetigo**, but ecthyma gangrenosum is not its typical presentation. - While *S. aureus* is a significant pathogen in immunocompromised patients, the constellation of severe neutropenia and a rapidly progressive, necrotic skin lesion characteristic of ecthyma gangrenosum points more strongly to *Pseudomonas*. *Vibrio vulnificus* - *Vibrio vulnificus* causes severe skin infections, particularly in individuals with **liver disease** or those exposed to **contaminated seawater** or raw seafood. - This patient's history of leukemia and stem cell transplantation, without mention of relevant exposures, makes *Vibrio vulnificus* a less likely pathogen in this scenario.
Question 6: All of the following are good prognostic factors for pediatric acute lymphoblastic leukemia, except:
- A. Hyperdiploidy
- B. CNS disease at diagnosis (Correct Answer)
- C. t(12;21)
- D. Initial WBC count <50,000/cumm
Explanation: ***CNS disease at diagnosis*** - The presence of **central nervous system (CNS) disease at diagnosis** in pediatric acute lymphoblastic leukemia (ALL) signifies a more aggressive form of the disease. - This involvement indicates a higher risk of relapse and is associated with a **poorer prognosis**, requiring more intensive treatment strategies. - CNS involvement is classified as a **high-risk feature** in ALL risk stratification protocols. *Hyperdiploidy* - **Hyperdiploidy**, specifically a **DNA index > 1.16** (>50 chromosomes), is considered a **favorable prognostic factor** in pediatric ALL. - It is associated with increased sensitivity to chemotherapy and thus a **better treatment outcome**. - High hyperdiploidy accounts for ~25% of pediatric ALL cases and confers excellent prognosis. *Initial WBC count <50,000/cumm* - An **initial WBC count <50,000/cumm** at diagnosis is a well-established **good prognostic factor** in pediatric ALL. - Lower WBC counts indicate lower tumor burden and are associated with **better treatment response and survival**. - WBC ≥50,000/cumm is classified as high-risk, making values below this threshold favorable. *t(12;21)* - The chromosomal translocation **t(12;21)(p13;q22)**, which results in the **ETV6-RUNX1 (TEL-AML1) fusion gene**, is the most common translocation in pediatric ALL (~25% of cases). - This genetic abnormality is indicative of a **favorable prognosis** with high rates of complete remission and a **reduced risk of relapse**. - It is associated with excellent long-term survival rates in pediatric ALL.
Question 7: Which of the following is the platinum-based chemotherapeutic agent used as first-line treatment for ovarian carcinoma?
- A. Cyclophosphamide
- B. Methotrexate
- C. Cisplatin (Correct Answer)
- D. Dacarbazine
Explanation: ***Cisplatin*** - **Cisplatin** is a platinum-based chemotherapy drug that forms **DNA cross-links**, inhibiting DNA synthesis and leading to the death of rapidly dividing cells, making it highly effective against **ovarian carcinoma**. - It is a cornerstone of chemotherapy regimens for ovarian cancer, often used in combination with other agents such as paclitaxel. *Methotrexate* - **Methotrexate** is an **antimetabolite** that inhibits dihydrofolate reductase, thereby interfering with DNA synthesis. - While it is used in various cancers like leukemia, lymphoma, and some solid tumors (e.g., breast cancer, gestational trophoblastic disease), it is **not a primary recommended drug for ovarian carcinoma**. *Cyclophosphamide* - **Cyclophosphamide** is an **alkylating agent** that causes DNA damage, leading to cell death. - It is used in many cancers, including lymphoma, breast cancer, and some leukemias, but it is **not a first-line or primary agent for ovarian carcinoma** in contemporary treatment guidelines. *Dacarbazine* - **Dacarbazine** is an **alkylating agent** primarily used in the treatment of **malignant melanoma** and Hodgkin lymphoma. - It is **not indicated for the treatment of ovarian carcinoma**.
Question 8: Choose the correct option regarding graft rejection.
- A. CD4 and CD8 both play a role in graft rejection (Correct Answer)
- B. None of the options
- C. CD8 only plays a role in graft rejection
- D. CD4 only plays a role in graft rejection
Explanation: ***CD4 and CD8 both play a role in graft rejection*** - **CD4+ T cells** (helper T cells) recognize donor MHC class II molecules and differentiate into effector cells that produce cytokines, promoting inflammation and activating other immune cells involved in rejection - **CD8+ T cells** (cytotoxic T lymphocytes, CTLs) recognize donor MHC class I molecules and directly kill donor cells in the graft, leading to tissue destruction - Both T cell subsets are crucial for initiating and mediating different aspects of the immune response against transplanted organs *CD8 only plays a role in graft rejection* - This is incorrect because while **CD8+ T cells** are vital for direct cytotoxicity, **CD4+ T cells** are also essential for orchestrating the overall immune response - **CD4+ T cells** provide help to B cells and CD8+ T cells, and their cytokines can also directly injure graft tissue *CD4 only plays a role in graft rejection* - This is incorrect because although **CD4+ T cells** are critical for initiating and amplifying the immune response through cytokine production and activation of other cells, **CD8+ T cells** are directly responsible for killing graft cells - Both cell types contribute significantly to the complex pathophysiology of graft rejection
Question 9: Most common complication after intestinal transplantation is
- A. Intestinal obstruction
- B. Graft vs host disease
- C. Intestinal necrosis
- D. Sepsis (Correct Answer)
Explanation: ***Sepsis*** - **Infection** is the leading cause of morbidity and mortality after intestinal transplantation, making **sepsis** the most common complication. - The immunocompromised state due to immunosuppressive therapy and the inherent bacterial load of the gastrointestinal tract contribute significantly to the high risk of severe infections. *Intestinal obstruction* - While intestinal obstruction can occur post-transplant due to adhesions or strictures, it is **less common** than infectious complications. - It typically manifests later and may require surgical intervention but doesn't have the same high frequency as sepsis. *Graft versus host disease* - **Graft-versus-host disease (GVHD)** is a significant complication in intestinal transplantation, but it is **not the most common**. - Its incidence varies, and while serious, it does not surpass the overall frequency of infectious complications and sepsis. *Intestinal necrosis* - **Intestinal necrosis** (e.g., due to infarction or severe rejection) is a severe complication but is **less frequent** than sepsis. - It is often a consequence of vascular compromise or overwhelming rejection, leading to graft failure or perforation.
Question 10: The Hematopoietic syndrome results when acute whole-body radiation exposure is above:
- A. 200 rad
- B. 400 rad
- C. 50 rad
- D. 100 rad (Correct Answer)
Explanation: ***100 rad*** - The **hematopoietic syndrome** is consistently observed in individuals exposed to whole-body radiation doses of **100 rad (1 Gy)** or higher. - This dose causes significant damage to the **bone marrow**, leading to the suppression of blood cell production and increased susceptibility to infection and hemorrhage. *200 rad* - While a dose of **200 rad** would certainly cause the hematopoietic syndrome, its onset is typically observed at a lower threshold of **100 rad**. - At 200 rad, the syndrome would be more severe, with prolonged pancytopenia and higher mortality if left untreated. *400 rad* - Exposure to **400 rad** is generally considered the **lethal dose for 50% of the population (LD50/60)** without medical intervention, signifying a very severe form of the hematopoietic syndrome. - At this dose, individuals would experience profound bone marrow suppression and are at very high risk for life-threatening infections and bleeding within weeks. *50 rad* - Exposure to **50 rad** typically causes only mild, temporary changes in blood counts, such as a transient decrease in lymphocytes, but generally does not lead to the full clinical picture of the **hematopoietic syndrome**. - While some subtle effects on bone marrow might occur, significant clinical symptoms requiring aggressive intervention are usually not seen at this dose.
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