Patient experienced progressive new lower extremity

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Reference no: EM133911786

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S.T. is a 67-year-old man who presented to the ER with dyspnea and weakness. Labs drawn: WBC white blood cell 4,300 mcl, Hgb hemoglobin 5.3 g/dl, Platelets-16,000 mcl

The initial blood smear showed acute lymphoblastic leukemia. Although, the final pathological evidence confirmed high-risk, CD20-+, stage IVB diffuse large B-cell lymphoma. Evaluation confirmed palpable spleen and elevated lactate dehydrogenase, which are high-risk features for bone marrow involvement.

The patient received 6 cycles of standard chemotherapy protocol: R-CHOP rituxan, cyclophosphamide, vincristine, doxorubicin, and prednisone. During treatment, central nervous system was prophylaxed with intrathecal methotrexate biweekly. After treatment results:

Initial staging lumbar puncture was negative

Aggressive leukemic phase presentation and bone marrow involvement

Post-treatment PET/CT scan consistent with complete remission

Cerebrospinal fluid analysis remained negative throughout treatment.

Referred to another provider for peripheral stem cell transplantation eligibility

The patient experienced progressive new lower extremity weakness over 3-4 weeks, during pretransplantation evaluation, requiring use of a wheelchair. Due to this new weakness, the transplantation was delayed as the next 4 months due to multiple hospitalizations for continued neurologic deterioration. Neurologic changes were development of left 3rd cranial nerve palsy and severe bilateral motor neuropathy with a component of sensory neuropathy. PET/CT scan of the brain, spine, cerebrospinal fluid analysis were negative. A MRI scan was not performed due to the patients pacemaker.

The patient was diagnosed with an atypical Gillian barre syndrome after consulting with neurology.

Drug 3: Vincristine DX: Atypical Guillian-Barre Syndrome

Explain use of RCHOP (rituxan, cyclophosphamide, vincristine, doxorubicin, and prednisone). Support or refute whether it is standard protocol. Include information for pharmacology and support with evidence within the last 5 years.

Identify pharmacological options, indications of use, mechanism of action, side effects (most common), contraindications, required observations, labs, and nursing actions/interventions.

Reference no: EM133911786

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