SCT Question 20
A 63 year old female with Ph- ALL is being conditioned for transplant in CR1. On the monring of day -3, you are informed that she had a fever of 102 last night and has new onset hypoxia requiring O2. NP swab is positive for SARS CoV2. Thus far the patient has recieved rabbit anti-thymocyte globulin 5 mg/kg total dose and 3 days of fludarabine at 30 mg/m^2. She is due for fludarabine dose 4 today and Melphalan 140 mg/m^2 on day -2. Tacrolimus is to be started today. The unrelated donor is having peripheral blood stem cells collected at a European center and is supposed to undergo apheresis the following day.
Your next step will be to
- Start remdesevir, continue conditioning with Flu/Mel and proceed with transplant
- Start remdesevir, change conditioning regimen to Flu/Cyclophosphamide and proceed with transplant
- Supportive care and hold further conditioning, cancel donor mobilization
- Start remdesevir, hold conditioning, request donor cells collected be cryopreserved and defer transplant
- Start remdesevir, stop further conditioning chemotherapy and proceed with tacrolimus and transplant
Option 4. This question patient is getting a reduced intensity conditioning regimen, and has thus far only received immunoablative conditioning, and has not received myeloablative therapy (Melphalan) yet. Given the likely covid pneumonia, it is prudent to stop conditioning to prevent myeloablation and abort the transplant at this stage to avoid further immune suppression and treat the SARS CoV2 infection. Since the donor has already received GCSF for 3-4 days, the product should be collected and cryopreserved. Once the patient has recovered, they may be reconditioned and transplanted. In the event this patient had received myeloablative therapy (Melphalan) as well, the correct answer would be to proceed with transplant, because now the patient needs to recover counts at the soonest possible time.
Published In/Presented At
Toor, A. (2023). SCT Question 20. LVHN Scholarly Works. Retrieved from https://scholarlyworks.lvhn.org/medicine/6052
Medicine and Health Sciences
Department of Medicine