SCT Question 2

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Question 2

You are asked to evaluate a patient receiving GCSF for hematopoietic stem cell mobilization. This is a 65-year-old patient, weighing 100 KG, with a h/o transformed follicular lymphoma who is in complete remission. This is the fifth day of GCSF 960 micrograms SC daily for stem cell mobilization. Yesterday you had seen him for persistent, throbbing pain in his back, sternum and ribs which responded to acetaminophen. Today he c/o moderate LUQ and mild L shoulder pain, which is persistent. He is not in distress and vital signs are at the upper limit of normal range for both HR and BP, RR is 24 with normal SaO2 and body temperature. There is mild LUQ tenderness on exam, without palpable organomegaly. WBC ct. is 45,000/microL, blood CD34+ cell ct. is 40/microL.

What is your next Rx step?

  1. Perform a sepsis evaluation and start broad spectrum antibiotics
  2. Stop GCSF and cancel apheresis
  3. Obtain CT CAP to evaluate relapsed NHL
  4. Give GCSF and proceed with apheresis
  5. Hold GCSF and proceed with apheresis

Answer Q2

Option 5. This patient has developed splenomegaly while getting 10 micrograms/kg/d GCSF for stem cell mobilization, although not commonly seen this may be complicated by splenic rupture. This patient is mildly symptomatic and hemodynamically stable so the likelihood of this severe complication is low. The blood CD34+ cell count predicts optimal timing for stem cell collection, therefore the patient should proceed with apheresis with careful observation. Abdominal imaging will be appropriate to rule out splenic pathology, but stem cell collection should be prioritized to avoid missing the window of optimal yield. Given splenic symptoms and adequate CD34+ cells in circulation, the GCSF administration may be deferred until stem cell yield of the procedure is known that afternoon.


Department of Medicine

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