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Haubitz M, von Petersdorff VS, Helsen I, Brunold C, Oppliger Leibundgut E, Baerlocher GM. Higher Age (≥60 Years) Increases the Risk for Adverse Events during Autologous Hematopoietic Stem Cell Transplantation. Cancers (Basel) 2023; 15:cancers15051584. [PMID: 36900376 PMCID: PMC10000699 DOI: 10.3390/cancers15051584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 02/22/2023] [Accepted: 02/28/2023] [Indexed: 03/08/2023] Open
Abstract
Autologous hematopoietic stem cell transplantation (autoHSCT) is a standard of care for patients with hemato-oncologic diseases. This procedure is highly regulated, and a quality assurance system needs to be in place. Deviations from defined processes and outcomes are reported as adverse events (AEs: any untoward medical occurrence temporally associated with an intervention that may or may not have a causal relationship), including adverse reactions (ARs: a response to a medicinal product which is noxious and unintended). Only a few reports on AEs cover the procedure of autoHSCT from collection until infusion. Our aim was to investigate the occurrence and severity of AEs in a large data set of patients who were treated by autoHSCT. In this retrospective, observational, single-center study on 449 adult patients during the years 2016-2019, AEs occurred in 19.6% of the patients. However, only 6.0% of patients had ARs, which is a low rate compared to the percentages (13.5-56.9%) found in other studies; 25.8% of the AEs were serious and 57.5% were potentially serious. Larger leukapheresis volumes, lower numbers of collected CD34+ cells and larger transplant volumes significantly correlated with the occurrence and number of AEs. Importantly, we found more AEs in patients >60 years (see graphical abstract). By preventing potentially serious AEs of quality and procedural issues, AEs could be reduced by 36.7%. Our results provide a broad view on AEs and point out steps and parameters for the potential optimization of the autoHSCT procedure, especially in elderly patients.
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Affiliation(s)
- Monika Haubitz
- Laboratory for Hematopoiesis and Molecular Genetics, Experimental Hematology, Department for BioMedical Research (DBMR), University of Bern, 3008 Bern, Switzerland
| | - Vittoria S. von Petersdorff
- Laboratory for Hematopoiesis and Molecular Genetics, Experimental Hematology, Department for BioMedical Research (DBMR), University of Bern, 3008 Bern, Switzerland
| | - Ingrid Helsen
- Laboratory for Hematopoiesis and Molecular Genetics, Experimental Hematology, Department for BioMedical Research (DBMR), University of Bern, 3008 Bern, Switzerland
| | - Claudio Brunold
- Department of Hematology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Elisabeth Oppliger Leibundgut
- Laboratory for Hematopoiesis and Molecular Genetics, Experimental Hematology, Department for BioMedical Research (DBMR), University of Bern, 3008 Bern, Switzerland
- Department of Hematology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Gabriela M. Baerlocher
- Laboratory for Hematopoiesis and Molecular Genetics, Experimental Hematology, Department for BioMedical Research (DBMR), University of Bern, 3008 Bern, Switzerland
- Department of Hematology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
- Correspondence:
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Hashimoto S, Kato K, Kai S, Sekimoto T, Minemoto M, Ishii H, Mori T, Azuma F, Ishimaru F, Kimura T, Miyata S, Satake M, Takanashi M. Adverse events caused by cord blood infusion in Japan during a 5-year period. Vox Sang 2023; 118:84-92. [PMID: 36454585 DOI: 10.1111/vox.13379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 09/09/2022] [Accepted: 11/06/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND AND OBJECTIVES In Japan, cord blood is used for more than half of all unrelated stem cell transplantations. The public cord blood banks (CBBs) have been collecting information on cord blood transplantation-related adverse events from physicians on a voluntary basis, without common definitions of the adverse reactions. The aims of this study were to compare two classification systems to improve the reporting system and to clarify the actual risk from cord blood infusion, which can then provide the impetus to take appropriate measures to reduce adverse events. MATERIALS AND METHODS We classified the reports according to existing criteria; one is the Proposed Standard Definitions for Surveillance of Non-Infectious Adverse Transfusion Reactions by the International Society of Blood Transfusion (ISBT) Working Party on Haemovigilance, and the other is the Common Terminology Criteria for Adverse Events (CTCAE). There were 140 cases with adverse events reported from April 2014 through March 2019. RESULTS Twelve cases, such as donor-derived leukaemia/myelodysplastic syndromes (MDS) and chromosomal aberrations reported after engraftment, were excluded from this analysis. Of the 128 cases with adverse events at cord blood infusion, the CTCAE and ISBT criteria could not classify 6 cases and 68 cases, respectively. Classifying by the CTCAE, the most common side effect was hypertension in 35 cases, followed by anaphylaxis, allergic reactions, nausea, urticaria, etc. Serious adverse events (grades 4 and 5) were mainly anaphylaxis, with a frequency of 0.23%. CONCLUSION It is necessary not only to provide information on adverse events but also to standardize the reporting of adverse events to support measures to reduce them.
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Affiliation(s)
- Shiho Hashimoto
- Central Blood Institute, Blood Service Headquarters, Japanese Red Cross Society, Tokyo, Japan
| | - Koji Kato
- Central Japan Cord Blood Bank, Aichi, Japan
| | | | - Tatsuya Sekimoto
- Japanese Red Cross Society Hokkaido Cord Blood Bank, Hokkaido, Japan
| | - Mutsuko Minemoto
- Japanese Red Cross Society Kanto-Koshinetsu Cord Blood Bank, Tokyo, Japan
| | - Hiroyuki Ishii
- Japanese Red Cross Society Kinki Cord Blood Bank, Osaka, Japan
| | - Tetsuo Mori
- Japanese Red Cross Society Kyushu Cord Blood Bank, Fukuoka, Japan
| | - Fumihiro Azuma
- Central Blood Institute, Blood Service Headquarters, Japanese Red Cross Society, Tokyo, Japan
| | - Fumihiko Ishimaru
- Japanese Red Cross Society Kanto-Koshinetsu Cord Blood Bank, Tokyo, Japan
| | - Takafumi Kimura
- Japanese Red Cross Society Kinki Cord Blood Bank, Osaka, Japan
| | - Shigeki Miyata
- Central Blood Institute, Blood Service Headquarters, Japanese Red Cross Society, Tokyo, Japan
| | - Masahiro Satake
- Central Blood Institute, Blood Service Headquarters, Japanese Red Cross Society, Tokyo, Japan
| | - Minoko Takanashi
- Central Blood Institute, Blood Service Headquarters, Japanese Red Cross Society, Tokyo, Japan
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Araújo AB, Soares TB, Schmalfuss T, Angeli MH, Furlan JM, Salton GD, Burin MM, Röhsig LM. Non-cryopreserved peripheral blood stem cells as a safe and effective alternative for autologous transplantation in multiple myeloma. Transfusion 2022; 62:1967-1972. [PMID: 36052689 DOI: 10.1111/trf.17090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 07/21/2022] [Accepted: 07/22/2022] [Indexed: 01/10/2023]
Abstract
BACKGROUND Autologous stem cell transplantation is the standard procedure for multiple myeloma and the grafts are usually cryopreserved. Previous studies reported advantages in the use of fresh peripheral blood stem cells (PBSC) autotransplantation compared to cryopreservation of the grafts. This study compared the transplant-related outcomes of two graft preservation methods: fresh storage (4°C/72 h) and cryopreservation (-80°C). STUDY DESIGN AND METHODS We performed an analysis of 45 patients with multiple myeloma under autotransplantation (17 fresh and 28 cryopreserved) from 2017 to 2021. Fresh PBSC were maintained in the refrigerator for three days in a concentration up to 300 × 103 TNC/μL. Cryopreserved PBSC were concentrated by plasma reduction after centrifugation (950 g/10 min/4°C) and an equal volume of cryoprotection solution was added for a final concentration of 300 × 103 TNC/μL, 5% DMSO, 6% hydroxyethyl starch, and 3% human albumin. RESULTS Neutrophil engraftment was significantly faster with fresh PBSCs (10 vs. 11.5 days, p = 0.045). Adverse effects were more common in cryopreserved PBSC transplantation (75% vs. 35.3% patients; p = 0.013). Post transplantation hospital stay was 20 and 22 days for fresh and cryopreserved PBSCs respectively (p = 0.091). There was no difference in platelet engraftment time (10.5 days for both; p = 0.133), number of antibiotics used after transplantation (3 for fresh and 2.5 for cryopreserved; p = 0.828), days of antibiotic use after transplantation (12.2 days for fresh and 13.3 days for cryopreserved, p = 0.579), and overall survival (p = 0.736). CONCLUSION The infusion of fresh PBSC refrigerated for up to three days is effective and safe for autologous transplantation in patients with multiple myeloma, which is a useful alternative to cryopreserved PBSC.
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Affiliation(s)
- Anelise Bergmann Araújo
- Centro de Processamento Celular, Serviço de Hemoterapia, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Tahiane Brum Soares
- Serviço de Hematologia, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Tissiana Schmalfuss
- Centro de Processamento Celular, Serviço de Hemoterapia, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Melissa Helena Angeli
- Centro de Processamento Celular, Serviço de Hemoterapia, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Juliana Monteiro Furlan
- Centro de Processamento Celular, Serviço de Hemoterapia, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Gabrielle Dias Salton
- Centro de Processamento Celular, Serviço de Hemoterapia, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | | | - Liane Marise Röhsig
- Centro de Processamento Celular, Serviço de Hemoterapia, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
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Chan AML, Ng AMH, Mohd Yunus MH, Hj Idrus RB, Law JX, Yazid MD, Chin KY, Shamsuddin SA, Mohd Yusof MR, Razali RA, Mat Afandi MA, Hassan MNF, Ng SN, Koh B, Lokanathan Y. Safety study of allogeneic mesenchymal stem cell therapy in animal model. Regen Ther 2022; 19:158-165. [PMID: 35252487 PMCID: PMC8861582 DOI: 10.1016/j.reth.2022.01.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 12/01/2021] [Accepted: 01/27/2022] [Indexed: 02/05/2023] Open
Abstract
Intravenous (IV) infusion of mesenchymal stem cells (MSCs) from nascent tissues like Wharton's Jelly of the umbilical cord is reported to offer therapeutic effects against chronic diseases. However, toxicological data essential for the clinical application of these cells are limited. Thus, this study aimed to determine the safety of IV infusion of Wharton's Jelly derived MSCs (WJ-MSCs) in rats. Fifteen male Sprague–Dawley rats were randomised into the control or treatment group. Each group received an equal volume of saline or WJ-MSC (10 × 106 cell/kg) respectively. The animals were evaluated for physical, biochemical and haematological changes at Week 0, 2, 4, 8 and 12 during the 12-week study. Acute toxicity was performed during Week 2 and sub-chronic toxicity during Week 12. At the end of the study, the relative weight of organs was calculated and histology was performed for lung, liver, spleen and kidney. The findings from physical, serum biochemistry and complete blood count demonstrated no statistically significant differences between groups. However, pathological evaluation reported minor inflammation in the lungs for all groups, but visible healing and resolution of inflammation were observed in the treatment group only. Additionally, the histological images of the treatment group had significantly improved pulmonary structures compared to the control group. In summary, the IV administration of WJ-MSC was safe in the rats. Further studies are needed to determine the long-term safety of the WJ-MSC in both healthy and diseased animal models. Intravenous infusion of high-dose WJ-MSC in rats is safe. No physical, biochemical and haematological adverse side effects were observed from the treatment. WJ-MSC successfully suppressed inflammation and stimulated regeneration in histopathological analysis.
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Affiliation(s)
- Alvin Man Lung Chan
- Centre for Tissue Engineering and Regenerative Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, 56000, Kuala Lumpur, Malaysia
- Ming Medical Sdn Bhd, D3-3 (2nd Floor), Block D3 Dana 1 Commercial Centre, Jalan PJU 1a/46, 47301, Petaling Jaya, Selangor, Malaysia
| | - Angela Min Hwei Ng
- Centre for Tissue Engineering and Regenerative Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, 56000, Kuala Lumpur, Malaysia
| | - Mohd Heikal Mohd Yunus
- Department of Physiology, Faculty of Medicine, Universiti Kebangsaan Malaysia, 56000, Kuala Lumpur, Malaysia
| | - Ruszymah Bt Hj Idrus
- Centre for Tissue Engineering and Regenerative Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, 56000, Kuala Lumpur, Malaysia
| | - Jia Xian Law
- Centre for Tissue Engineering and Regenerative Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, 56000, Kuala Lumpur, Malaysia
| | - Muhammad Dain Yazid
- Centre for Tissue Engineering and Regenerative Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, 56000, Kuala Lumpur, Malaysia
| | - Kok-Yong Chin
- Department of Pharmacology, Faculty of Medicine, Universiti Kebangsaan Malaysia, 56000, Kuala Lumpur, Malaysia
| | - Sharen Aini Shamsuddin
- Centre for Tissue Engineering and Regenerative Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, 56000, Kuala Lumpur, Malaysia
| | - Mohd Rafizul Mohd Yusof
- Department of Parasitology and Medical Entomology, Faculty of Medicine, Universiti Kebangsaan Malaysia, 56000, Kuala Lumpur, Malaysia
| | - Rabiatul Adawiyah Razali
- Centre for Tissue Engineering and Regenerative Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, 56000, Kuala Lumpur, Malaysia
| | - Mohd Asyraf Mat Afandi
- Centre for Tissue Engineering and Regenerative Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, 56000, Kuala Lumpur, Malaysia
| | - Muhammad Najib Fathi Hassan
- Centre for Tissue Engineering and Regenerative Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, 56000, Kuala Lumpur, Malaysia
| | - See Nguan Ng
- Ming Medical Sdn Bhd, D3-3 (2nd Floor), Block D3 Dana 1 Commercial Centre, Jalan PJU 1a/46, 47301, Petaling Jaya, Selangor, Malaysia
| | - Benson Koh
- Centre for Tissue Engineering and Regenerative Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, 56000, Kuala Lumpur, Malaysia
- Ming Medical Sdn Bhd, D3-3 (2nd Floor), Block D3 Dana 1 Commercial Centre, Jalan PJU 1a/46, 47301, Petaling Jaya, Selangor, Malaysia
| | - Yogeswaran Lokanathan
- Centre for Tissue Engineering and Regenerative Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, 56000, Kuala Lumpur, Malaysia
- Corresponding author.
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5
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Semenova E, Grudniak MP, Bocian K, Chroscinska-Krawczyk M, Trochonowicz M, Stepaniec IM, Murzyn M, Szablowska-Gadomska I, Boruczkowski D, Oldak T, Machaj EK. Banking of AT-MSC and its Influence on Their Application to Clinical Procedures. Front Bioeng Biotechnol 2021; 9:773123. [PMID: 34917599 PMCID: PMC8670380 DOI: 10.3389/fbioe.2021.773123] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 11/11/2021] [Indexed: 01/09/2023] Open
Abstract
Processing of MSCs to obtain a therapeutic product consists of two main steps: 1) the in vitro expansion of the cells until an appropriate number of them is obtained, and 2) freezing and storage of the expanded cells. The last step is critical and must be optimized so that after thawing the cells retain all their physiological properties including the secretory function. In this paper, we evaluated physiological parameters of AT-MSC's after a full cycle of their processing, particularly freezing and storing at the liquid nitrogen vapor temperature. Based on the recovered proliferative and secretory capacities of the thawed cells, we have designed the optimal technique for processing of MSCs for clinical applications. In our work, we tried to select the best DMSO-based cryoprotectant mixture on the base of post thawing fully retain their properties. We have demonstrated the effectiveness of the use of DMSO in various configurations of the constituent cryoprotective fluids. We have also shown that AT-MSCs that show control levels in most standard tests (viability, shape, culture behaviour, and proliferative properties) after thawing, may show transient variations in some important physiological properties, such as the level of secreted growth factors. Obtained results let us to indicate how to optimize the AT-MSC preparation process for clinical applications. We suggest that before their clinical application the cells should be cultured for at least one passage to recover their physiological stability and thus assure their optimal therapeutic potential.
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Affiliation(s)
| | | | - Katarzyna Bocian
- Polish Stem Cell Bank, FamiCord Group, Warsaw, Poland.,Department of Immunology, Faculty of Biology, University of Warsaw, Warsaw, Poland
| | | | | | | | - Magdalena Murzyn
- Polish Stem Cell Bank, FamiCord Group, Warsaw, Poland.,Institute of Human Genetics, Polish Academy of Sciences, Poznan, Poland
| | | | | | - Tomasz Oldak
- Polish Stem Cell Bank, FamiCord Group, Warsaw, Poland
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Purtill D, Hutchins C, Kennedy G, McClean A, Fraser C, Shaw PJ, Chiappini P, Tao H, Ma DD, Kabani K, Bai L, Greenwood M, Bajel A, O'Flaherty E, Curtis DJ, Purins L, Perera T, Tan S, Butler A, Micklethwaite K, Antonenas V, Gottlieb D, Hamad N. Good Engraftment but Quality and Donor Concerns for Cryopreserved Hemopoietic Progenitor Cell Products Collected During the COVID-19 Pandemic. Transplant Cell Ther 2021; 27:1022.e1-1022.e6. [PMID: 34571211 DOI: 10.1016/j.jtct.2021.09.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 09/05/2021] [Accepted: 09/19/2021] [Indexed: 10/20/2022]
Abstract
Changes to donor availability, collection center capacity, and travel restrictions during the early phase of the COVID-19 pandemic led to routine cryopreservation of most unrelated donor products for hematopoietic transplantation prior to the recipient commencing the conditioning regimen. We investigated the effect of this change on unrelated donor product quality and clinical outcomes. Product information was requested from transplantation centers in Australia and New Zealand and clinical outcome data from the Australasian Bone Marrow Transplant Recipient Registry (ABMTRR). In total, 191 products were collected between April 1, 2021, and September 30, 2021, and most (74%) were from international collection centers. Median post-thaw CD34 recovery was 78% (range 25% to 176%) and median post-thaw CD34 viability was 87% (range 34% to 112%). Median time to neutrophil recovery was 17 days (interquartile range 10 to 24 days), and graft failure occurred in 6 patients (4%). These clinical outcomes were similar to those of "fresh" unrelated donor transplants reported to the ABMTRR in 2019. However, recipient transplantation centers reported problems with 29% of products in the form of damage during transit, low cell dose, inadequate labeling, missing representative samples, or missing documentation. These problems were critical in 7 cases (4%). At last follow-up, 22 products (12%) had not been infused. Routine cryopreservation of unrelated donor hemopoietic progenitor cell products has enabled safe continuation of allogeneic transplant services during the COVID-19 pandemic. However, practices for product tracing, documentation, and transportation can be optimized, and measures to reduce the incidence of unused unrelated donor product are required.
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Affiliation(s)
- Duncan Purtill
- Blood and Marrow Transplant Program, Fiona Stanley Hospital, Perth, Australia; Bone Marrow Transplant Laboratory, PathWest Laboratory Medicine WA, Perth, Australia.
| | | | - Glen Kennedy
- Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Andrea McClean
- Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Chris Fraser
- Queensland Children's Hospital, Brisbane, Australia
| | - Peter J Shaw
- Blood Transplant and Cell Therapies Program, The Children's Hospital at Westmead, Sydney, Australia; Speciality of Child and Adolescent Health, The University of Sydney, Sydney, Australia
| | - Paul Chiappini
- Bone Marrow Transplant Laboratory, PathWest Laboratory Medicine WA, Perth, Australia
| | - Helen Tao
- Department of Haematology and Bone Marrow Transplantation, St. Vincent's Hospital, Sydney, Australia
| | - David Df Ma
- Department of Haematology and Bone Marrow Transplantation, St. Vincent's Hospital, Sydney, Australia; St. Vincent's Clinical School, Faculty of Medicine, University of New South Wales, Kensington, Australia
| | | | - Lijun Bai
- Cellular Therapeutic Laboratory, Northern Blood Research Centre, Royal North Shore Hospital, Sydney, Australia
| | - Matthew Greenwood
- Royal North Shore Hospital, Sydney, Australia; The University of Sydney, Sydney, Australia
| | - Ashish Bajel
- Clinical Haematology, Peter MacCallum Cancer Centre and The Royal Melbourne Hospital, Melbourne, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | - Elizabeth O'Flaherty
- Clinical Haematology, Peter MacCallum Cancer Centre and The Royal Melbourne Hospital, Melbourne, Australia
| | - David J Curtis
- Alfred Health, Melbourne, Australia; Australian Centre for Blood Diseases, Monash University, Melbourne, Australia
| | - Leanne Purins
- Cellular Therapies Laboratory, SA Pathology, Adelaide, Australia
| | - Travis Perera
- Wellington Blood and Cancer Centre, Wellington Hospital, Wellington, New Zealand
| | - Sarah Tan
- Department of Haematology, Auckland District Health Board, Auckland, New Zealand
| | - Andrew Butler
- South Island Blood and Marrow Transplant Program, Christchurch Hospital, Christchurch, New Zealand
| | - Ken Micklethwaite
- Blood Transplant and Cell Therapies Program, Westmead Hospital, Sydney, Australia; Blood Transplant and Cell Therapies Laboratory, NSW Health Pathology ICPMR Westmead, Sydney, Australia
| | - Vicki Antonenas
- Blood Transplant and Cell Therapies Laboratory, NSW Health Pathology ICPMR Westmead, Sydney, Australia
| | - David Gottlieb
- Blood Transplant and Cell Therapies Program, Westmead Hospital, Sydney, Australia; Sydney Medical School, University of Sydney, Sydney, Australia
| | - Nada Hamad
- Department of Haematology and Bone Marrow Transplantation, St. Vincent's Hospital, Sydney, Australia; St. Vincent's Clinical School, Faculty of Medicine, University of New South Wales, Kensington, Australia
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7
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Infusion reactions in natural killer cell immunotherapy: a retrospective review. Cytotherapy 2021; 23:627-634. [PMID: 33980470 DOI: 10.1016/j.jcyt.2021.03.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 02/12/2021] [Accepted: 03/29/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND AIMS The use of natural killer (NK) cells as a cellular immunotherapy has increased over the past decade, specifically in patients with hematologic malignancies. NK cells have been used at the authors' institution for over 15 years. Most patients have a reaction to NK cell infusion. The authors retrospectively analyzed the reactions associated with NK cell infusions to characterize the types of reactions and investigate why some patients have higher-grade reactions than others. METHODS A retrospective chart review of NK cell infusions was performed at the authors' institution under nine clinical protocols from 2008 to 2016. An infusion reaction was defined as any symptom from the time of NK cell infusion up to 4 h after infusion completion. The severity of infusion reactions was graded based on Common Terminology Criteria for Adverse Events, version 4. Two major endpoints of interest were (i) infusion reaction with any symptom and (ii) grade ≥3 infusion reaction. Multivariable logistic regression models were used to investigate the association between variables of interest and outcomes. Odds ratios (ORs) and 95% confidence intervals (CIs) were obtained for each variable. RESULTS A total of 130 patients were receiving NK cell infusions at the authors' institution. The most common reported symptom was chills (n = 110, 85%), which were mostly grade 1 and 2, with only half of patients requiring intervention. There were 118 (91%) patients with infusion reactions, and only 36 (28%) were grade 3. There was one life-threatening grade 4 reaction, and no death was reported due to infusion reaction. Among grade ≥3 reactions, cardiovascular reactions (mainly hypertension) were the most common, and less than half of those with hypertension required intervention. NK cell dose was not associated with any of the grade 3 infusion reactions, whereas monocyte dose was associated with headache (grade ≤3, OR, 2.17, 95% CI, 1.19-3.97) and cardiovascular reaction (grade ≥3, OR, 2.13, 95% CI, 1.13-3.99). Cardiovascular reaction (grade ≥3) was also associated with in vitro IL-2 incubation and storage time. Additionally, there was no association between grade ≥3 infusion reactions and overall response rate (OR, 0.75, 95% CI, 0.29-1.95). CONCLUSIONS The majority of patients who receive NK cell therapy experience grade 1 or 2 infusion reactions. Some patients experience grade 3 reactions, which are mainly cardiovascular, suggesting that close monitoring within the first 4 h is beneficial. The association of monocytes with NK cell infusion reaction relates to toxicities seen in adoptive T-cell therapy and needs further exploration.
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8
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Adkins BD, Booth GS, Vasu S. Transfusion support for stem cell transplant recipients. Semin Hematol 2020; 57:51-56. [PMID: 32892843 DOI: 10.1053/j.seminhematol.2020.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 06/04/2020] [Accepted: 07/15/2020] [Indexed: 01/28/2023]
Abstract
Hematopoietic stem cell patients regularly require transfusion support. Indications for transfusion in this population are similar to other patients being treated with chemoradiation; however, special considerations must be made in regards to pretransfusion testing, ABO compatibility, product modifications, and anticipated challenges while patients undergo engraftment. Additionally, infusion of hematopoietic stem cells requires acute understanding of product collection, modification, and potential side effects. As these patients often require numerous platelet transfusions, platelet refractoriness may be encountered and practice options are discussed. We review current indications and guidelines for transfusion in hematopoietic stem cell patients and make recommendations for best practice based on current literature.
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Affiliation(s)
- Brian D Adkins
- Department of Pathology, University of Virginia Health System, Charlottesville, VA, USA
| | - Garrett S Booth
- The Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sumithira Vasu
- Division of Hematology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA.
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9
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Ikeda K, Ohto H, Yamada‐Fujiwara M, Okuyama Y, Fujiwara S, Muroi K, Mori T, Kasama K, Kanamori H, Iseki T, Nagamura‐Inoue T, Kameda K, Kanda J, Nagai K, Fujii N, Ashida T, Hirose A, Takahashi T, Minakawa K, Tanosaki R. Hematopoietic cell infusion‐related adverse events in pediatric/small recipients in a prospective/multicenter study. Transfusion 2020; 60:1015-1023. [DOI: 10.1111/trf.15786] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 02/02/2020] [Accepted: 03/03/2020] [Indexed: 12/15/2022]
Affiliation(s)
- Kazuhiko Ikeda
- Cell Therapy CommitteeJapan Society of Transfusion Medicine and Cell Therapy Tokyo Japan
- Department of Blood Transfusion and Transplantation ImmunologyFukushima Medical University Fukushima Japan
| | - Hitoshi Ohto
- Cell Therapy CommitteeJapan Society of Transfusion Medicine and Cell Therapy Tokyo Japan
- Department of Blood Transfusion and Transplantation ImmunologyFukushima Medical University Fukushima Japan
| | - Minami Yamada‐Fujiwara
- Cell Therapy CommitteeJapan Society of Transfusion Medicine and Cell Therapy Tokyo Japan
- Division of Blood Transfusion and Cell TherapyTohoku University Hospital Sendai Japan
| | - Yoshiki Okuyama
- Cell Therapy CommitteeJapan Society of Transfusion Medicine and Cell Therapy Tokyo Japan
- Division of Transfusion and Cell TherapyTokyo Metropolitan Komagome Hospital Tokyo Japan
| | - Shin‐ichiro Fujiwara
- Cell Therapy CommitteeJapan Society of Transfusion Medicine and Cell Therapy Tokyo Japan
- Division of Hematology, Department of MedicineJichi Medical University Shimotsuke Japan
| | - Kazuo Muroi
- Cell Therapy CommitteeJapan Society of Transfusion Medicine and Cell Therapy Tokyo Japan
- Cell Transplantation and TransfusionJichi Medical University Tochigi Japan
| | - Takehiko Mori
- Division of Hematology, Department of MedicineKeio University School of Medicine Tokyo Japan
| | - Kinuyo Kasama
- Department of Transfusion MedicineTokyo Jikei University Hospital Tokyo Japan
| | - Heiwa Kanamori
- Cell Therapy CommitteeJapan Society of Transfusion Medicine and Cell Therapy Tokyo Japan
- Department of HematologyKanagawa Cancer Center Yokohama Japan
| | - Tohru Iseki
- Cell Therapy CommitteeJapan Society of Transfusion Medicine and Cell Therapy Tokyo Japan
- Department of Transfusion Medicine and Cell TherapyChiba University Hospital Chiba Japan
| | - Tokiko Nagamura‐Inoue
- Cell Therapy CommitteeJapan Society of Transfusion Medicine and Cell Therapy Tokyo Japan
- Institution of Medical ScienceUniversity of Tokyo Tokyo Japan
| | - Kazuaki Kameda
- Division of Hematology, Saitama Medical CenterJichi Medical University Saitama Japan
| | - Junya Kanda
- Department of Hematology and OncologyGraduate School of Medicine, Kyoto University Kyoto Japan
| | - Kazuhiro Nagai
- Transfusion and Cell Therapy UnitNagasaki University Hospital Nagasaki Japan
| | - Nobuharu Fujii
- Department of Transfusion MedicineOkayama University Hospital Okayama‐shi Japan
| | - Takashi Ashida
- Center for Transfusion and Cell TherapyKindai University Hospital Osakasayama Japan
| | - Asao Hirose
- Department of HematologyOsaka City University Osaka Japan
| | - Tsutomu Takahashi
- Department of Oncology/HematologyShimane University Hospital Shimane Japan
| | - Keiji Minakawa
- Department of Blood Transfusion and Transplantation ImmunologyFukushima Medical University Fukushima Japan
| | - Ryuji Tanosaki
- Cell Therapy CommitteeJapan Society of Transfusion Medicine and Cell Therapy Tokyo Japan
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10
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Mahadeo KM, Khazal SJ, Abdel-Azim H, Fitzgerald JC, Taraseviciute A, Bollard CM, Tewari P, Duncan C, Traube C, McCall D, Steiner ME, Cheifetz IM, Lehmann LE, Mejia R, Slopis JM, Bajwa R, Kebriaei P, Martin PL, Moffet J, McArthur J, Petropoulos D, O'Hanlon Curry J, Featherston S, Foglesong J, Shoberu B, Gulbis A, Mireles ME, Hafemeister L, Nguyen C, Kapoor N, Rezvani K, Neelapu SS, Shpall EJ. Management guidelines for paediatric patients receiving chimeric antigen receptor T cell therapy. Nat Rev Clin Oncol 2019; 16:45-63. [PMID: 30082906 PMCID: PMC7096894 DOI: 10.1038/s41571-018-0075-2] [Citation(s) in RCA: 143] [Impact Index Per Article: 28.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
In 2017, an autologous chimeric antigen receptor (CAR) T cell therapy indicated for children and young adults with relapsed and/or refractory CD19+ acute lymphoblastic leukaemia became the first gene therapy to be approved in the USA. This innovative form of cellular immunotherapy has been associated with remarkable response rates but is also associated with unique and often severe toxicities, which can lead to rapid cardiorespiratory and/or neurological deterioration. Multidisciplinary medical vigilance and the requisite health-care infrastructure are imperative to ensuring optimal patient outcomes, especially as these therapies transition from research protocols to standard care. Herein, authors representing the Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network Hematopoietic Stem Cell Transplantation (HSCT) Subgroup and the MD Anderson Cancer Center CAR T Cell Therapy-Associated Toxicity (CARTOX) Program have collaborated to provide comprehensive consensus guidelines on the care of children receiving CAR T cell therapy.
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Affiliation(s)
- Kris M Mahadeo
- Department of Pediatrics, Stem Cell Transplantation and Cellular Therapy, CARTOX Program, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Sajad J Khazal
- Department of Pediatrics, Stem Cell Transplantation and Cellular Therapy, CARTOX Program, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Hisham Abdel-Azim
- Department of Pediatrics, Blood and Marrow Transplantation Program, Keck School of Medicine, University of Southern California, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Julie C Fitzgerald
- Department of Anesthesiology and Critical Care, Division of Critical Care, University of Pennsylvania Perelman School of Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Agne Taraseviciute
- Department of Pediatrics, Division of Hematology-Oncology, University of Washington, Seattle Children's Hospital, Seattle, WA, USA
| | - Catherine M Bollard
- Center for Cancer and Immunology Research and Department of Pediatrics, Children's National and The George Washington University, Washington DC, USA
| | - Priti Tewari
- Department of Pediatrics, Stem Cell Transplantation, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Christine Duncan
- Pediatric Hematology-Oncology, Dana-Farber Cancer Institute, Harvard University, Boston, MA, USA
| | - Chani Traube
- Department of Pediatric Critical Care, Weil Cornell Medical College, New York Presbyterian Hospital, New York, NY, USA
| | - David McCall
- Department of Pediatrics, Stem Cell Transplantation and Cellular Therapy, CARTOX Program, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Marie E Steiner
- Department of Pediatrics, Division of Critical Care, University of Minnesota, Masonic Children's Hospital, University of Minnesota, Minneapolis, MN, USA
| | - Ira M Cheifetz
- Department of Pediatrics, Division of Critical Care, Duke Children's Hospital, Duke University, Durham, NC, USA
| | - Leslie E Lehmann
- Pediatric Hematology-Oncology, Dana-Farber Cancer Institute, Harvard University, Boston, MA, USA
| | - Rodrigo Mejia
- Department of Pediatrics, Critical Care, CARTOX Program, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - John M Slopis
- Department of Pediatrics, Neurology, CARTOX Program, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Rajinder Bajwa
- Department of Pediatrics, Division of Blood and Marrow Transplantation, Nationwide Children's Hospital, the Ohio State University, Columbus, OH, USA
| | - Partow Kebriaei
- Department of Stem Cell Transplantation and Cellular Therapy, CARTOX Program, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Paul L Martin
- Department of Pediatrics, Division of Blood and Marrow Transplant, Duke Children's Hospital, Duke University, Durham, NC, USA
| | - Jerelyn Moffet
- Department of Pediatrics, Division of Blood and Marrow Transplant, Duke Children's Hospital, Duke University, Durham, NC, USA
| | - Jennifer McArthur
- Department of Pediatrics, Division of Critical Care, St. Jude's Children's Research Hospital, Memphis, TN, USA
| | - Demetrios Petropoulos
- Department of Pediatrics, Stem Cell Transplantation and Cellular Therapy, CARTOX Program, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Joan O'Hanlon Curry
- Department of Pediatrics, Stem Cell Transplantation and Cellular Therapy, CARTOX Program, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sarah Featherston
- Department of Pediatrics, Stem Cell Transplantation and Cellular Therapy, CARTOX Program, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jessica Foglesong
- Department of Pediatrics, Stem Cell Transplantation and Cellular Therapy, CARTOX Program, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Basirat Shoberu
- Department of Pharmacy, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Alison Gulbis
- Department of Pharmacy, CARTOX Program, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Maria E Mireles
- Department of Pharmacy, CARTOX Program, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Lisa Hafemeister
- Department of Pediatrics, Stem Cell Transplantation and Cellular Therapy, CARTOX Program, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Cathy Nguyen
- Department of Pediatrics, Stem Cell Transplantation and Cellular Therapy, CARTOX Program, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Neena Kapoor
- Department of Pediatrics, Blood and Marrow Transplantation Program, Keck School of Medicine, University of Southern California, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Katayoun Rezvani
- Department of Stem Cell Transplantation and Cellular Therapy, CARTOX Program, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sattva S Neelapu
- Department of Lymphoma and Myeloma, CARTOX Program, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Elizabeth J Shpall
- Department of Stem Cell Transplantation and Cellular Therapy, CARTOX Program, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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11
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Figueiredo TWB, Mercês NNAD, Nunes MBM, Wall ML. Adverse reactions on day zero of hematopoietic stem cell transplantation: integrative review. ACTA ACUST UNITED AC 2018; 39:e20180095. [PMID: 30517435 DOI: 10.1590/1983-1447.2018.20180095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 08/14/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To identify the adverse reactions associated with the infusion of hematopoietic stem cells on day zero of hematopoietic stem cell transplantation. METHODOLOGY Integrative literature review, without temporal cut, with search in the following databases: PubMed, CINAHL, SCOPUS, BVS, SciELO, Web of Science and CAPES; the final sample consisted of 18 scientific articles, published between 1998 and 2017, based on the inclusion and exclusion criteria. RESULTS Mild and moderate adverse reactions were the most frequent in studies that used the classification by severity, and nausea and emesis had the highest incidence; the most affected organ systems were the cardiovascular, respiratory and gastrointestinal. CONCLUSION The main adverse reactions identified in the studies were nausea and emesis. Those classified as mild and moderate were the most frequent in the studies that used the severity classification; and the cardiovascular, respiratory and gastrointestinal systems were the most affected in those that used the classification by organic systems.
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Affiliation(s)
- Talita Wérica Borges Figueiredo
- Universidade Federal do Paraná (UFPR), Complexo Hospital de Clínicas (CHC-UFPR). Curitiba, Paraná, Brasil.,Universidade Federal do Paraná (UFPR), Departamento de Enfermagem, Programa de Pós-Graduação em Enfermagem. Curitiba, Paraná, Brasil
| | - Nen Nalú Alves das Mercês
- Universidade Federal do Paraná (UFPR), Departamento de Enfermagem, Programa de Pós-Graduação em Enfermagem. Curitiba, Paraná, Brasil
| | - Mariana Bertotti Mendes Nunes
- Universidade Federal do Paraná (UFPR), Complexo Hospital de Clínicas (CHC-UFPR). Curitiba, Paraná, Brasil.,Universidade Federal do Paraná (UFPR), Departamento de Enfermagem, Programa de Pós-Graduação em Enfermagem. Curitiba, Paraná, Brasil
| | - Marilene Loewen Wall
- Universidade Federal do Paraná (UFPR), Departamento de Enfermagem, Programa de Pós-Graduação em Enfermagem. Curitiba, Paraná, Brasil
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12
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Yu X, Liu S, Chen H, Zhao X, Chen X, Du Y, Li S. CGRP gene-modified rBMSCs show better osteogenic differentiation capacity in vitro. J Mol Histol 2018; 49:357-367. [PMID: 29846865 DOI: 10.1007/s10735-018-9775-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 05/10/2018] [Indexed: 12/14/2022]
Abstract
Calcitonin gene-related peptide (CGRP) is a marked and important neuropeptide expressed in nerve fibers during bone repair. This study investigated the role of CGRP overexpression on osteogenic differentiation of rat bone mesenchymal stem cells (rBMSCs). rBMSCs were infected with viral stocks of pLenO-DCE-CGRP (CGRP group) or pLenO-DCE (Vector group), while normal rBMSCs were used as a control. Transfection efficiency of rBMSCs was analyzed by flow cytometry. Cell proliferation was examined using a Cell Counting Kit-8 and flow cytometry. Expressions of alkaline phosphatase(ALP), bone sialoprotein (BSP) and Runt-related transcription factor 2(Runx2) in rBMSCs were detected at 1 and 2 weeks after mineral induction by real-time PCR and western blotting. Alizarin Red staining was applied at 28 days. The ratio of osteoprotegerin (OPG) to receptor activator of nuclear factor kappa B ligand (RANKL) was also detected to determine the underlying mechanism. pLenO-DCE-CGRP-induced rBMSCs stably overexpressing CGRP were successfully established. Overexpression of the CGRP gene significantly promoted rBMSC proliferation (p < 0.05). In addition, expressions of osteogenesis-related indexes were upregulated in the CGRP group (p < 0.05) compared with vector and control groups, and more mineralization nodules were observed in the CGRP group (p < 0.05). CGRP gene increased OPG and reduced RANKL in rBMSCs. Hence, the OPG/ RANKL ratio was increased in the CGRP group compared with the other two groups. CGRP gene-modified rBMSCs show better osteogenic differentiation capacity compared with rBMSCs in vitro.
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Affiliation(s)
- Xijiao Yu
- Shandong Provincial Key Laboratory of Oral Tissue Regeneration, Department of Periodontology, School and Hospital of Stomatology, Shandong University, 44-1 West Wenhua Road, Jinan, 250012, Shandong, People's Republic of China.,Department of Endodontics, Jinan Stomatological Hospital, Jinan, Shandong, People's Republic of China
| | - Shuang Liu
- Shandong Provincial Key Laboratory of Oral Tissue Regeneration, Department of Periodontology, School and Hospital of Stomatology, Shandong University, 44-1 West Wenhua Road, Jinan, 250012, Shandong, People's Republic of China
| | - Hui Chen
- Department of Endodontics, Jinan Stomatological Hospital, Jinan, Shandong, People's Republic of China
| | - Xinyu Zhao
- Shandong Provincial Key Laboratory of Oral Tissue Regeneration, Department of Periodontology, School and Hospital of Stomatology, Shandong University, 44-1 West Wenhua Road, Jinan, 250012, Shandong, People's Republic of China
| | - Xue Chen
- Shandong Provincial Key Laboratory of Oral Tissue Regeneration, Department of Periodontology, School and Hospital of Stomatology, Shandong University, 44-1 West Wenhua Road, Jinan, 250012, Shandong, People's Republic of China
| | - Yi Du
- Department of Endodontics, Jinan Stomatological Hospital, Jinan, Shandong, People's Republic of China
| | - Shu Li
- Shandong Provincial Key Laboratory of Oral Tissue Regeneration, Department of Periodontology, School and Hospital of Stomatology, Shandong University, 44-1 West Wenhua Road, Jinan, 250012, Shandong, People's Republic of China.
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13
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Heneghan C, Smilow E, Tanhehco Y, Jin Z, Cofnas P, Schwartz S, Patel N, Carberry D, Silverman J, Huynh P, Hagan B, Tobin K, Bhatia M, George D, Garvin J, Satwani P. Safety of hematopoietic cell infusion in children with malignant and non-malignant diseases. Pediatr Transplant 2017; 21. [PMID: 28845921 DOI: 10.1111/petr.13038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/27/2017] [Indexed: 12/25/2022]
Abstract
HPC infusions have been associated with a variety of adverse events related to either patient or HPC product-related factors. Studies documenting infusion-related AEs in children are limited. We reviewed HPC infusion records in 354 children. Infusion-related adverse events were classified as follows: grade 0-absent, grade I-mild, grade II-moderate, grade III-severe, grade IV-life-threatening, and grade V-death. The percentage of patients with grade 0, I, and II-IV AEs was as follows: 0 = 67%, I = 23.4%, and II-V = 9.6% (one patient had fatal anaphylactic reaction to dimethyl sulfoxide). The incidence of grade II-IV hypertension was 7.1%. There was a higher incidence of AEs with infusion of allogeneic bone marrow versus allogeneic PBSCs (47.4% vs 25.3%, P = .001). Cryopreserved products had a lower incidence of infusion-associated AEs compared with fresh HPC products (24% vs 39.4%, P = .003). Allogeneic HPC infusion volume (>100 mL) was a significant risk factor for infusion-associated AEs (P < .001). Patients >10 years who received autologous HPC infusions had higher risk of AEs when compared to patients <10 years (P = .01). Our study demonstrated that despite a high incidence of infusion-associated hypertension, HPC infusion is relatively safe in children. Investigating strategies to optimize management of hypertension in the setting of HPC infusion is warranted.
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Affiliation(s)
- Chelsea Heneghan
- Department of Nursing, Morgan Stanly Children's Hospital of New York Presbyterian, New York, NY, USA
| | - Elana Smilow
- Department of Nursing, Morgan Stanly Children's Hospital of New York Presbyterian, New York, NY, USA
| | - Yvette Tanhehco
- Department of Pathology, Columbia University, New York, NY, USA
| | - Zhezhen Jin
- Department of Biostatistics, Columbia University, New York, NY, USA
| | - Paige Cofnas
- Department of Nursing, Morgan Stanly Children's Hospital of New York Presbyterian, New York, NY, USA
| | - Sharon Schwartz
- Department of Nursing, Morgan Stanly Children's Hospital of New York Presbyterian, New York, NY, USA
| | - Nita Patel
- Department of Pathology, Columbia University, New York, NY, USA
| | | | - Justin Silverman
- Department of Pediatrics, Columbia University, New York, NY, USA
| | - Paul Huynh
- Department of Pediatrics, Columbia University, New York, NY, USA
| | - Brittany Hagan
- Department of Nursing, Morgan Stanly Children's Hospital of New York Presbyterian, New York, NY, USA
| | - Kim Tobin
- Department of Nursing, Morgan Stanly Children's Hospital of New York Presbyterian, New York, NY, USA
| | - Monica Bhatia
- Department of Pediatrics, Columbia University, New York, NY, USA
| | - Diane George
- Department of Pediatrics, Columbia University, New York, NY, USA
| | - James Garvin
- Department of Pediatrics, Columbia University, New York, NY, USA
| | - Prakash Satwani
- Department of Pediatrics, Columbia University, New York, NY, USA
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