Residency Program - Case of the Month

History:

The patient is a 30-year-old male with a history of Hodgkin lymphoma which was diagnosed 5 years ago.  He received chemotherapy followed by an allogenic stem cell transplant in 2013.  He subsequently developed poikiloderma, keratoconjunctivitis sicca, chronic diarrhea and lost 20% of his weight over a period of 4 months.  His treatment involved apheresis methods to alleviate his symptoms.  However, in December 2014, he developed cervical lymphadenopathy with continued weight loss.  A lymph node biopsy revealed recurrent Hodgkin lymphoma.

Discussion Questions:

Recently his weight has started to increase, and therefore chemotherapy is being held for now by the patient's oncology team.

1. What was the condition he developed after allogenic stem cell transplant?
2. What type of apheresis procedure is recommended to alleviate symptoms belonging to this condition?
3. What is the mechanism of action in this procedure?
4. What are the ASFA Category and ASFA Grading Recommendations?

5. What is the appropriate apheresis plan for this patient’s current status?

 Answer