CT-564 ELARA Trial Update: Long-Term Clinical Outcomes and Correlative Efficacy Analyses of Tisagenlecleucel in Patients with Relapsed/Refractory Follicular Lymphoma (R/R FL)

upon evaluation, was deemed secondary to a parasitic infection.Case Report: A 76-year-old man from Dominican Republic was diagnosed with smoldering myeloma in 2012 and progressed into symptomatic myeloma requiring systemic chemotherapy followed by his first autologous stem cell transplant in 2022.The hospital course was complicated by diarrhea and neutropenic fever, which was resolved with antibiotics.A restaging bone marrow biopsy showed 10% residual plasma cells and he underwent his second transplant in 2023.He again developed neutropenic fever and diarrhea with unrevealing computed tomography (CT) imaging and blood cultures.The fevers and his symptoms improved after blood count recovery, and he was discharged.On Day 40 posttransplant, he was readmitted with profuse diarrhea (6-8/day) and fevers.This time, CT imaging showed long-segment distal small bowel thickening with mucosal enhancement and submucosal edema and a small bowel 1.1-cm mass.He gave a history of passing white cylindrical objects in his stools.A stool sent for ova and parasite evaluation came back as non-diagnostic.Because the patient had copious diarrhea, we started him empirically on albendazole.Owing to the failure to diagnose the organism in the stool physically, the specimen was subjected to pathological examination.On pathological examination, gelatinous cystic walllike structure associated with necro inflammatory structure with exudate was noted.The patient's diarrhea gradually improved with no other therapy and repeat imaging was normal.Discussion: The patient likely had a parasitic infestation, which based on the physical appearance resembled, Ascaris lumbricoides.The failure to diagnose the parasite is probably secondary to the anti-helminthic medication started presumptively.In immunocompromised patients such as those undergoing transplant, a detailed travel history and physical examination should be done to diagnose the cause of infection.A broader differential with early testing must be considered in patients undergoing transplant due to their weakened immunity.