BMTCN Blood and marrow transplant
certification recognizing specialized
competencies in transplantation care and
patient management.
Question 1
A patient is scheduled for an allogeneic hematopoietic stem cell transplant (HSCT)
for acute myeloid leukemia. The APRN explains that the PRIMARY goal of the
graft-versus-tumor (GVT) effect is:
A. Prevention of graft rejection
B. Eradication of residual malignant cells by donor immune cells
C. Promotion of rapid hematopoietic engraftment
D. Reduction of conditioning regimen toxicity
Answer: B. Eradication of residual malignant cells by donor immune cells
Rationale: The graft-versus-tumor (GVT) effect is a desirable immune-mediated
response in which donor-derived T cells recognize and eliminate residual
malignant cells that survived the conditioning regimen. This effect is the primary
therapeutic advantage of allogeneic transplantation over autologous
transplantation. While prevention of graft rejection, promotion of engraftment, and
reduction of toxicity are important goals, they are not the primary definition of the
GVT effect. The GVT effect is closely linked to graft-versus-host disease
(GVHD), as both involve donor immune cell activity against recipient tissues.
Question 2
A 45-year-old patient with multiple myeloma is being evaluated for autologous
stem cell transplantation. Which of the following is the MOST appropriate source
of stem cells for this patient?
A. Matched unrelated donor peripheral blood stem cells
B. The patient's own peripheral blood stem cells
,C. Umbilical cord blood from a sibling
D. Haploidentical donor bone marrow
Answer: B. The patient's own peripheral blood stem cells
Rationale: Autologous transplantation uses the patient's own stem cells, which are
typically collected from peripheral blood following mobilization with growth
factors (e.g., G-CSF) with or without chemotherapy. This approach avoids the risks
of GVHD and graft rejection, making it the preferred option for multiple myeloma
and other malignancies where a graft-versus-tumor effect is not essential. Matched
unrelated donors, umbilical cord blood, and haploidentical donors are used for
allogeneic transplants.
Question 3
A patient with severe aplastic anemia is being evaluated for a hematopoietic stem
cell transplant. Which type of transplant is MOST appropriate for this non-
malignant indication?
A. Autologous transplant
B. Allogeneic transplant from a matched sibling donor
C. Syngeneic transplant from an identical twin
D. Autologous transplant with purging
Answer: B. Allogeneic transplant from a matched sibling donor
Rationale: For non-malignant diseases such as severe aplastic anemia, allogeneic
transplantation is the treatment of choice to replace the defective hematopoietic
system with healthy donor cells. A matched sibling donor (MSD) is the preferred
donor source due to the lowest risk of GVHD and graft rejection. Autologous
transplantation would not correct the underlying defect in aplastic anemia, and
syngeneic transplants are only possible with an identical twin, which is rare.
Question 4
A patient undergoing evaluation for allogeneic HSCT is found to be HLA-matched
with an unrelated donor. The APRN explains that the primary function of HLA
matching is to:
,A. Ensure the donor and recipient have the same blood type
B. Reduce the risk of graft rejection and GVHD
C. Increase the graft-versus-tumor effect
D. Ensure the donor is of the same gender
Answer: B. Reduce the risk of graft rejection and GVHD
Rationale: Human leukocyte antigen (HLA) matching is critical in allogeneic
transplantation to minimize the risk of graft rejection and graft-versus-host disease
(GVHD). HLA molecules present peptides to T cells, and mismatches can trigger
immune responses against the graft or the recipient's tissues. While HLA matching
may influence the GVT effect and blood type compatibility is important for
transfusion support, the primary purpose is to reduce immune-mediated
complications. Gender matching is not a primary consideration.
Question 5
A patient with chronic myeloid leukemia (CML) is being evaluated for allogeneic
HSCT. The APRN recognizes that which of the following is a key indication for
transplantation in CML?
A. Failure of tyrosine kinase inhibitor (TKI) therapy
B. Presence of the Philadelphia chromosome
C. Age greater than 65 years
D. White blood cell count greater than 50,000/mm³
Answer: A. Failure of tyrosine kinase inhibitor (TKI) therapy
Rationale: In the era of TKIs (e.g., imatinib, dasatinib), allogeneic HSCT for CML
is typically reserved for patients who fail TKI therapy, develop TKI resistance, or
progress to accelerated phase or blast crisis. The presence of the Philadelphia
chromosome is the hallmark of CML but is not an indication for transplant if the
patient responds to TKIs. Age >65 is a relative contraindication due to increased
transplant-related mortality, and a high WBC count alone does not indicate
transplant.
Question 6
A patient with sickle cell disease is being evaluated for a hematopoietic stem cell
, transplant. The APRN explains that the goal of transplantation in this non-
malignant disease is to:
A. Eradicate the sickle cell gene
B. Replace the defective hematopoietic system with healthy donor cells
C. Provide a graft-versus-tumor effect
D. Reduce the need for blood transfusions
Answer: B. Replace the defective hematopoietic system with healthy donor
cells
Rationale: For non-malignant diseases such as sickle cell disease, the goal of
allogeneic HSCT is to replace the patient's defective hematopoietic system with
healthy donor cells that produce normal hemoglobin. This corrects the underlying
genetic defect. The GVT effect is relevant only for malignant diseases. While
reducing transfusion needs is a benefit, it is not the primary goal of transplantation.
Question 7
A patient is being prepared for peripheral blood stem cell (PBSC) collection for an
autologous transplant. The APRN should educate the patient that the MOST
common mobilization regimen includes:
A. Granulocyte colony-stimulating factor (G-CSF) alone
B. G-CSF plus chemotherapy
C. Plerixafor alone
D. Erythropoietin plus G-CSF
Answer: B. G-CSF plus chemotherapy
Rationale: The most common mobilization regimen for autologous PBSC
collection combines G-CSF with chemotherapy (e.g., cyclophosphamide). The
chemotherapy provides disease control while the G-CSF mobilizes stem cells from
the bone marrow into the peripheral blood. G-CSF alone may be used in some
settings, but the combination is more effective for most patients. Plerixafor is used
in patients who mobilize poorly. Erythropoietin is not used for stem cell
mobilization.
certification recognizing specialized
competencies in transplantation care and
patient management.
Question 1
A patient is scheduled for an allogeneic hematopoietic stem cell transplant (HSCT)
for acute myeloid leukemia. The APRN explains that the PRIMARY goal of the
graft-versus-tumor (GVT) effect is:
A. Prevention of graft rejection
B. Eradication of residual malignant cells by donor immune cells
C. Promotion of rapid hematopoietic engraftment
D. Reduction of conditioning regimen toxicity
Answer: B. Eradication of residual malignant cells by donor immune cells
Rationale: The graft-versus-tumor (GVT) effect is a desirable immune-mediated
response in which donor-derived T cells recognize and eliminate residual
malignant cells that survived the conditioning regimen. This effect is the primary
therapeutic advantage of allogeneic transplantation over autologous
transplantation. While prevention of graft rejection, promotion of engraftment, and
reduction of toxicity are important goals, they are not the primary definition of the
GVT effect. The GVT effect is closely linked to graft-versus-host disease
(GVHD), as both involve donor immune cell activity against recipient tissues.
Question 2
A 45-year-old patient with multiple myeloma is being evaluated for autologous
stem cell transplantation. Which of the following is the MOST appropriate source
of stem cells for this patient?
A. Matched unrelated donor peripheral blood stem cells
B. The patient's own peripheral blood stem cells
,C. Umbilical cord blood from a sibling
D. Haploidentical donor bone marrow
Answer: B. The patient's own peripheral blood stem cells
Rationale: Autologous transplantation uses the patient's own stem cells, which are
typically collected from peripheral blood following mobilization with growth
factors (e.g., G-CSF) with or without chemotherapy. This approach avoids the risks
of GVHD and graft rejection, making it the preferred option for multiple myeloma
and other malignancies where a graft-versus-tumor effect is not essential. Matched
unrelated donors, umbilical cord blood, and haploidentical donors are used for
allogeneic transplants.
Question 3
A patient with severe aplastic anemia is being evaluated for a hematopoietic stem
cell transplant. Which type of transplant is MOST appropriate for this non-
malignant indication?
A. Autologous transplant
B. Allogeneic transplant from a matched sibling donor
C. Syngeneic transplant from an identical twin
D. Autologous transplant with purging
Answer: B. Allogeneic transplant from a matched sibling donor
Rationale: For non-malignant diseases such as severe aplastic anemia, allogeneic
transplantation is the treatment of choice to replace the defective hematopoietic
system with healthy donor cells. A matched sibling donor (MSD) is the preferred
donor source due to the lowest risk of GVHD and graft rejection. Autologous
transplantation would not correct the underlying defect in aplastic anemia, and
syngeneic transplants are only possible with an identical twin, which is rare.
Question 4
A patient undergoing evaluation for allogeneic HSCT is found to be HLA-matched
with an unrelated donor. The APRN explains that the primary function of HLA
matching is to:
,A. Ensure the donor and recipient have the same blood type
B. Reduce the risk of graft rejection and GVHD
C. Increase the graft-versus-tumor effect
D. Ensure the donor is of the same gender
Answer: B. Reduce the risk of graft rejection and GVHD
Rationale: Human leukocyte antigen (HLA) matching is critical in allogeneic
transplantation to minimize the risk of graft rejection and graft-versus-host disease
(GVHD). HLA molecules present peptides to T cells, and mismatches can trigger
immune responses against the graft or the recipient's tissues. While HLA matching
may influence the GVT effect and blood type compatibility is important for
transfusion support, the primary purpose is to reduce immune-mediated
complications. Gender matching is not a primary consideration.
Question 5
A patient with chronic myeloid leukemia (CML) is being evaluated for allogeneic
HSCT. The APRN recognizes that which of the following is a key indication for
transplantation in CML?
A. Failure of tyrosine kinase inhibitor (TKI) therapy
B. Presence of the Philadelphia chromosome
C. Age greater than 65 years
D. White blood cell count greater than 50,000/mm³
Answer: A. Failure of tyrosine kinase inhibitor (TKI) therapy
Rationale: In the era of TKIs (e.g., imatinib, dasatinib), allogeneic HSCT for CML
is typically reserved for patients who fail TKI therapy, develop TKI resistance, or
progress to accelerated phase or blast crisis. The presence of the Philadelphia
chromosome is the hallmark of CML but is not an indication for transplant if the
patient responds to TKIs. Age >65 is a relative contraindication due to increased
transplant-related mortality, and a high WBC count alone does not indicate
transplant.
Question 6
A patient with sickle cell disease is being evaluated for a hematopoietic stem cell
, transplant. The APRN explains that the goal of transplantation in this non-
malignant disease is to:
A. Eradicate the sickle cell gene
B. Replace the defective hematopoietic system with healthy donor cells
C. Provide a graft-versus-tumor effect
D. Reduce the need for blood transfusions
Answer: B. Replace the defective hematopoietic system with healthy donor
cells
Rationale: For non-malignant diseases such as sickle cell disease, the goal of
allogeneic HSCT is to replace the patient's defective hematopoietic system with
healthy donor cells that produce normal hemoglobin. This corrects the underlying
genetic defect. The GVT effect is relevant only for malignant diseases. While
reducing transfusion needs is a benefit, it is not the primary goal of transplantation.
Question 7
A patient is being prepared for peripheral blood stem cell (PBSC) collection for an
autologous transplant. The APRN should educate the patient that the MOST
common mobilization regimen includes:
A. Granulocyte colony-stimulating factor (G-CSF) alone
B. G-CSF plus chemotherapy
C. Plerixafor alone
D. Erythropoietin plus G-CSF
Answer: B. G-CSF plus chemotherapy
Rationale: The most common mobilization regimen for autologous PBSC
collection combines G-CSF with chemotherapy (e.g., cyclophosphamide). The
chemotherapy provides disease control while the G-CSF mobilizes stem cells from
the bone marrow into the peripheral blood. G-CSF alone may be used in some
settings, but the combination is more effective for most patients. Plerixafor is used
in patients who mobilize poorly. Erythropoietin is not used for stem cell
mobilization.
