Sign-in to Ask A Doctor - 24x7
OR
Sign in with Google
Dear Dr XXXXXXX Thanks For Your Advice To My Earlier
Question: Dear Dr XXXXXXX
Thanks for your advice to my earlier thread
https://www.healthcaremagic.com/AskDoctorInboxServlet?page=viewQuery&queryId=393007
My niece (aged 24) has BMT for her SAA on 23 Oct 2019 with 9/10 MUD, with DRB1 mismatch. She has been discharged recently on Day 29 (today is Day 32). I got some questions and wish to have your expert views
My niece has fever prior to BMT preconditioning, and with antibiotics treatment, controlling fever around 37.4- 37.8 degree celcius, she proceeded to BMT. Her fever has not ever subsided, always between 37.2- 37.8, some times higher than 38. With repeated tests, doctor said it is possibly due to CMV infection, and my niece is still under treatment for this, even after discharge. My worries –
1. With persistent low grade fever, do we need to worry much ? Does indicate severe potential complexities that could be fatal?
2. Is CMV infection common in BMT patient? How is this treated and usually takes how long for it to be resolved?
3. What should we be alert or pay special attention to during this period?
My niece should have engrafted, platelet around 60- 80 this week, still need RBC transfusion. ANC once XXXXXXX above 1 for more than 3 days but then fell to 0.94 a week ago and need a neupogen. Thank God, she has not experienced significant discomfort during the period. Is it a good sign? She seems has not GVHD so far, but doctor said that it is unpredictable when GVHD arise. It may arise any time.
My questions –
4. Is 9/10 likely give rise to GVHD? What are the factors affecting the appearance or non-appaearance of GVHD and its severity?
5. Her donor is a male, does it has a lower chance of GVHD compared to a female donor to a male recipient?
6. If patient has acute GVHD, does it mean that he has a higher chance of chronic GVHD? Or even if no acute GVHD, he is still at the same risk of chronic GVHD?
Appreciate much your expert advice.
Thanks for your advice to my earlier thread
https://www.healthcaremagic.com/AskDoctorInboxServlet?page=viewQuery&queryId=393007
My niece (aged 24) has BMT for her SAA on 23 Oct 2019 with 9/10 MUD, with DRB1 mismatch. She has been discharged recently on Day 29 (today is Day 32). I got some questions and wish to have your expert views
My niece has fever prior to BMT preconditioning, and with antibiotics treatment, controlling fever around 37.4- 37.8 degree celcius, she proceeded to BMT. Her fever has not ever subsided, always between 37.2- 37.8, some times higher than 38. With repeated tests, doctor said it is possibly due to CMV infection, and my niece is still under treatment for this, even after discharge. My worries –
1. With persistent low grade fever, do we need to worry much ? Does indicate severe potential complexities that could be fatal?
2. Is CMV infection common in BMT patient? How is this treated and usually takes how long for it to be resolved?
3. What should we be alert or pay special attention to during this period?
My niece should have engrafted, platelet around 60- 80 this week, still need RBC transfusion. ANC once XXXXXXX above 1 for more than 3 days but then fell to 0.94 a week ago and need a neupogen. Thank God, she has not experienced significant discomfort during the period. Is it a good sign? She seems has not GVHD so far, but doctor said that it is unpredictable when GVHD arise. It may arise any time.
My questions –
4. Is 9/10 likely give rise to GVHD? What are the factors affecting the appearance or non-appaearance of GVHD and its severity?
5. Her donor is a male, does it has a lower chance of GVHD compared to a female donor to a male recipient?
6. If patient has acute GVHD, does it mean that he has a higher chance of chronic GVHD? Or even if no acute GVHD, he is still at the same risk of chronic GVHD?
Appreciate much your expert advice.
Brief Answer:
Persistent fever signifies infection usually
Detailed Answer:
Hi
Thanks for your query.
Persistent fever can be because of any infection. In her case, it appears that the infection is identified as CMV. CMV is not uncommon in this setting and pre emptive therapy with ganciclovir is required in most cases. Probably already started in her. We need to carefully monitor her liver and renal function during this time.
GVHD incidence rises with HLA mismatch, age of recipient, specific types of conditioning regime, etc. Male donor to female recipient actually reduces GVHD. More acute GVHD leads to more chronic GVHD but even without acute GVHD one can have chronic GVHD.
Her counts are not of much concern at this. time. CMV or its treatment can also lead to lower counts.
Hopefully she will do well.
Regards
Persistent fever signifies infection usually
Detailed Answer:
Hi
Thanks for your query.
Persistent fever can be because of any infection. In her case, it appears that the infection is identified as CMV. CMV is not uncommon in this setting and pre emptive therapy with ganciclovir is required in most cases. Probably already started in her. We need to carefully monitor her liver and renal function during this time.
GVHD incidence rises with HLA mismatch, age of recipient, specific types of conditioning regime, etc. Male donor to female recipient actually reduces GVHD. More acute GVHD leads to more chronic GVHD but even without acute GVHD one can have chronic GVHD.
Her counts are not of much concern at this. time. CMV or its treatment can also lead to lower counts.
Hopefully she will do well.
Regards
Note: For further follow up on related General & Family Physician Click here.
Above answer was peer-reviewed by :
Dr. Prasad
Answered by
Get personalised answers from verified doctor in minutes across 80+ specialties
