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Occurrence of side efects during autologous peripheral blood hemopopetic progenitor Cell infusion is associated with composition of graft

Objectives: Toxicity related to autologous peripheral blood hematopoietic progenitor cell infusion (PBPC) has been well known. We prospectively evaluated the infusion-related toxicity of cryopreserved autologous PBPC in patients receiving high dose chemotherapy and stem cell transplantation for various hematologic or solid malignancies. The effects of cell quality in graft and the amount of DMSO infused on occurrence of adverse events were investigated. Materials: A prospective study of occurrence of the side- effects in 215patients during infusion of autologous PBSC was performed ; 42 patients underwent double autotransplantations. PBSC were collected by apheresis after mobilization with chemotherapy and/or G-CSF. The grafts were cryopreserved in 10 % DMSO and stored in liquid nitrogen. Before infusion, all patients received steroids and antihistaminic drugs over 30 minute. Grafts were rapidly thawed and infused without further processing. The neutrophil count, viability test and clonogenic assay were performed after thawing to determine whether cell quality was associated with occurrence of the side effects. Patients were monitored for vital signs and symptoms of the toxicity during and after infusion. The cryobiology laboratory technician was required to remain at the patient’s bedside during the infusion, and to record the duration of infusion and side-effects in questionnaire. Results: The side-effects were occured during 128 (49.8 %) infusions. Nausea(32.4 %), vomiting(22.0 %)and hypertension(17.8 %)were the most common adverse events. Other observed side effects were sore throat and unpleasant taste (4 %), abdominal cramping (3.5 %), cough (1.9 %), asymptomatic hypotension(1.9 %), dyspnea, headache, chills, hot flushes and erythema(0.4 %).There were no significant differences in the main characteristics of the patients(age, gender, body weight) and the type of pre-transplant conditioning regimens between the two groups. The patients who experienced sideeffects received significantly higher (P < 0.0001)volumeofgraftperkilogramofbodyweight.In these group the pre freeze neutrophil count ingraft was significantly higher (P = 0.009) and the cell viability was significantly lower (P = 0.02).Conclusions: We observed that the infusion of cryopreserved PBSC mainly caused minor to moderate toxicity. These toxicities have been shown to be associated with volume of infused cryoprotectant, the amount of neutrophils and the presence of dead cells in graft. Since our results indicate that the composition of graft is very important, the infusion-related toxicity could be probably reduced by improvement of quality of apheresis product as well as depletion of mature blood cells in graft which are poorly preserved through the cryopreservation process.

side efects, autologous peripheral blood hemopopetic progenitor, cell infusion, composition of graft

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