Devita, Hellman, and Rosenberg's Cancer

LWBK1006-42 LWW-Govindan-Review December 12, 2011 20:38

536 DeVita, Hellman, and Rosenberg’s CANCER: Principles and Practice of Oncology Review

grafts, or received grafts from identical twin donors. In some patients,

discontinuation of immunosuppression may be sufficient to induce regres-

sion of the leukemic clone. Each of these observations provides indirect

evidence of the existence of the GVL effect. Definitive evidence, however,

is derived from the ability of DLIs to reinduce complete remissions in the

absence of any additional cytotoxic therapy.

Answer 42.25. The answer is D.

Allogeneic HCT recipients remain at risk for various long-term complica-

tions, including skeletal complications (especially with chronic steroids),

infertility, secondary malignancies, and endocrine failure, for which ongo-

ing follow-up and monitoring are indicated.

Answer 42.26. The answer is B.

Several factors are associated with an increased risk of acute GVHD,

including recipient age, HLA disparity, and inadequate prophylaxis.

T-cell depletion of the graft decreases the incidence of GVHD.

Answer 42.27. The answer is D.

Unlike the early hemorrhagic cystitis that is usually caused by high-dose

cyclophosphamide, the late counterpart is usually of viral etiology, includ-

ing BK virus and adenovirus.

Answer 42.28. The answer is D.

Autologous stem cell transplantation has a role in the treatment of patients

with various solid tumors including neuroblastoma, Ewing sarcoma, and

testicular cancer. Since randomized clinical trials did not show survival

improvement for autologous stem cell transplantation in breast cancer,

this approach should be used only in the context of clinical trials.

Answer 42.29. The answer is B.

Attempts to purge tumor cells from autologous hematopoietic stem cell

grafts, using either negative or positive selection strategies, have not been

proven to reduce the risk of relapse or prolong overall survival.

Answer 42.30. The answer is A.

Autologous HCT is curative in approximately 40% to 50% of relapsed

diffuse large cell non-Hodgkin’s lymphoma cases but has not been shown

to be curative in the case of low-grade lymphoproliferative disorders,

multiple myeloma, or breast carcinoma.

Answer 42.31. The answer is A.

Idiopathic pulmonary syndrome is an inflammatory lung disease that may

occur within 3 months from transplant, is commonly associated with

CMV virus infection and prior radiation therapy, and may be fatal in up

to 50% of patients.