Module information

Module details

Title
Advanced H&I – Stem Cells
Type
Specialist
Module code
S-HAI-S2
Credits
10
Phase
3
Requirement
Compulsory

Aim of this module

The aim of this module is to provide the trainee with the knowledge and skills relating to Histocompatibility and Immunogenetics techniques applicable to haematopoietic stem cell transplantation. This module will provide the trainee with a knowledge and understanding of stem cell donation, testing, harvesting and post-transplant monitoring. They will gain experience in using human leukocyte antigen (HLA) typing results in the context of matching recipients with suitable donors in a variety of clinical settings.

Work-based content

Competencies

# Learning outcome Competency Action
# 1 Learning outcome 1 Competency

Identify a case with unusual HLA linkage and/or low frequency alleles, investigate appropriately and recommend further testing where required

Action View
# 2 Learning outcome 1,2,4 Competency

Perform an unrelated donor search, and review and select potential HLA matched unrelated donors for HSCT

Action View
# 3 Learning outcome 1,2,4 Competency

Perform a donor search  for a patient with no ‘HLA-matched’ donors and select potential alternative related or unrelated donors for HSCT

Action View
# 4 Learning outcome 1,2,3 Competency

Produce an interpretive report on the suitability of potential HLA matched HSCT donor for clinical colleagues

Action View
# 5 Learning outcome 1,2,3 Competency

Produce an interpretive report on the suitability of potential alternative HSCT donor for clinical colleagues

Action View
# 6 Learning outcome 1,2,3 Competency

Outline a donor option strategy for a patient awaiting HSCT

Action View
# 7 Learning outcome 3,4 Competency

Clinically interpret results of chimerism analysis to assess and monitor patients post HSCT

Action View
# 8 Learning outcome 5 Competency

Review and interpret and critically evaluate EQA results for HLA typing or chimerism analysis

Action View
# 9 Learning outcome 4,6 Competency

Present a case where a new or emerging technology or clinical intervention has been used for HSCT

Action View
# 10 Learning outcome 5,6 Competency

Attend a national meeting relevant to stem cell transplantation and provide feedback to your colleagues

Action View

Assessments

Complete 2 Case-Based Discussions

Complete 2 DOPS or OCEs

Direct Observation of Practical Skills Titles

  • Conduct a search for an unrelated stem cell donor.
  • Conduct a search for an unrelated cord blood donor.
  • Perform tests to monitor post-transplant engraftment.
  • Interpret results of post-transplant engraftment monitoring.

Observed Clinical Event Titles

  • Present laboratory results for an HSCT case at a multidisciplinary meeting.
  • Advise a clinician on the likelihood of finding a suitable donor for a patient awaiting HSCT.
  • Take a patient history from another healthcare professional to inform interpretation of results.

Learning outcomes

# Learning outcome
1

Apply the appropriate strategy for the investigation of patients being considered for haematopoietic stem cell transplantation (HSCT), interpret and report results of the investigation in the correct clinical context.

2

Assess the suitability of potential related and unrelated matched and mismatched donors for HSCT.

3

Perform clinical and laboratory monitoring of patients who have received HSCT.

4

Practice effectively in partnership with other clinical specialisms and the wider multidisciplinary team in the investigation of HSCT to deliver safe and effective patient care.

5

Evaluate external quality assurance results and comment on test performance.

6

Appraise emerging technologies and clinical advances in the context of HSCT.

Clinical experiences

Important information

Clinical experiences help you to develop insight into your practice and greater understanding of your specialty. Clinical experiences should be included in your training plan and you may be asked to help organise your experiences. While Clinical Experiences are not assessed, reflections and observations from your experiences can be used to support evidence for competencies to demonstrate your awareness and appreciation of your specialty and it’s impact on patient care. You may find it helpful to capture thoughts from your experiences in your reflective log.

Activities

To develop a broader understanding of their specialty practice and support the completion of assessments and competencies, it is recommended a trainee should:

  1. Attend ward rounds and clinics at which patients are being worked up for or monitored following HSCT.
  2. Attend a multidisciplinary review meeting at which laboratory results are presented for patients awaiting transplant or being monitored following HSCT.

Academic content (MSc in Clinical Science)

Important information

The academic parts of this module will be detailed and communicated to you by your university. Please contact them if you have questions regarding this module and its assessments. The module titles in your MSc may not be exactly identical to the work-based modules shown in the e-portfolio. Your modules will be aligned, however, to ensure that your academic and work-based learning are complimentary.

Learning outcomes

On successful completion of this module the trainee will be able to:

  1. Critically discuss the pathogenesis of malignant and non-malignant indications for HSCT.
  1. Explain the pre-conditioning therapies and post-transplant patient management associated with malignant and non-malignant indications for HSCT.
  2. Describe the processes involved in the preparation of haemopoietic stem cells for HSCT.
  3. Apply integrative knowledge of the post-transplant monitoring of HSCT.
  4. Describe the immunopathogenesis and evaluate the management of complications associated with HSCT.

Indicative content

Immunopathogenesis of haematological malignancies:

  • WHO classification.
  • Integrated diagnostic services and techniques (molecular, flow cytometry).
  • Prognostic risk factors of HSCT in malignant disorders.
  • Acute leukaemia (named exemplars; AML, ALL).
  • Use of autologous HSCT / CD34 counts.

Immunopathogenesis of non-malignant disorders:

  • Immunological disorders (primary immune deficiencies, primary immune regulatory disorders, autoimmune disorders.
  • Haematological disorders (red cell disorders, bone marrow failure).
  • Non-haematological (metabolic disorders).
  • Prognostic risk factors of HSCT in non-malignant disorders.

Complex donor selection:

  • Haploidentical.
  • Umbilical cord transplants (cord blood donor recruitment/collection/processing/banking/registration).
  • Mismatched unrelated donor.
  • KIR.
  • Bioinformatics tools for donor selection in HSCT.

Stem cell processing:

  • Donor retrieval (bone marrow harvests, peripheral blood mobilisation).
  • Aaseptic technique and cleanroom processes.
  • Role of CD34 monitoring.
  • Foundation for the Accreditation of Cellular Therapy (FACT).
  • GMP standards / MHRA / BSQR (in relation to cellular therapies).

Post-transplant monitoring of HSCT:

  • Measures of successful engraftment.
  • Antibody identification.
  • Chimerism analysis.
  • Minimal residual disease.

Immunosuppression:

  • Pre-transplant conditioning and post-transplant management.
  • Mechanisms of action.
  • Therapeutic monitoring.

Post-HSCT complications:

  • Graft versus host disease (acute and chronic).
  • Graft versus leukaemia.
  • Organ toxicities.
  • Donor lymphocyte infusions.

Advanced therapeutic medicinal products:

  • Cellular therapies.
  • Gene therapy and editing.
  • CAR-T.

Module assigned to

Specialties

Specialty code Specialty title Action
Specialty code SLS1-4-22 Specialty title Histocompatibility & Immunogenetics [2022] Action View