1
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Rolsma JL, Darch W, Higgins NC, Morgan JT. The tardigrade-derived mitochondrial abundant heat soluble protein improves adipose-derived stem cell survival against representative stressors. Sci Rep 2024; 14:11834. [PMID: 38783150 PMCID: PMC11116449 DOI: 10.1038/s41598-024-62693-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Accepted: 05/20/2024] [Indexed: 05/25/2024] Open
Abstract
Human adipose-derived stem cell (ASC) grafts have emerged as a powerful tool in regenerative medicine. However, ASC therapeutic potential is hindered by stressors throughout their use. Here we demonstrate the transgenic expression of the tardigrade-derived mitochondrial abundant heat soluble (MAHS) protein for improved ASC resistance to metabolic, mitochondrial, and injection shear stress. In vitro, MAHS-expressing ASCs demonstrate up to 61% increased cell survival following 72 h of incubation in phosphate buffered saline containing 20% media. Following up to 3.5% DMSO exposure for up to 72 h, a 14-49% increase in MAHS-expressing ASC survival was observed. Further, MAHS expression in ASCs is associated with up to 39% improved cell viability following injection through clinically relevant 27-, 32-, and 34-gauge needles. Our results reveal that MAHS expression in ASCs supports survival in response to a variety of common stressors associated with regenerative therapies, thereby motivating further investigation into MAHS as an agent for stem cell stress resistance. However, differentiation capacity in MAHS-expressing ASCs appears to be skewed in favor of osteogenesis over adipogenesis. Specifically, activity of the early bone formation marker alkaline phosphatase is increased by 74% in MAHS-expressing ASCs following 14 days in osteogenic media. Conversely, positive area of the neutral lipid droplet marker BODIPY is decreased by up to 10% in MAHS-transgenic ASCs following 14 days in adipogenic media. Interestingly, media supplementation with up to 40 mM glucose is sufficient to restore adipogenic differentiation within 14 days, prompting further analysis of mechanisms underlying interference between MAHS and differentiation processes.
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Affiliation(s)
- Jordan L Rolsma
- Department of Bioengineering, University of California, 900 University Ave, Riverside, CA, 92521, USA
| | - William Darch
- Department of Bioengineering, University of California, 900 University Ave, Riverside, CA, 92521, USA
| | - Nicholas C Higgins
- Department of Bioengineering, University of California, 900 University Ave, Riverside, CA, 92521, USA
| | - Joshua T Morgan
- Department of Bioengineering, University of California, 900 University Ave, Riverside, CA, 92521, USA.
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2
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Meriç N, Parmaksız A, Gülbaş Z. Determination of the relationship between CD34+ stem cell amount and DMSO in hematopoetic stem cell transplantation. Transpl Immunol 2023; 78:101831. [PMID: 37019290 DOI: 10.1016/j.trim.2023.101831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 03/25/2023] [Accepted: 03/27/2023] [Indexed: 04/05/2023]
Abstract
It is important to calculate the CD34+ stem cell (SC) count at the right time in patients with hematological malignancies who will undergo Hematopoietic Stem Cell Transplantation (HSCT). The amount of SC infused into the patient affects the engraftment time and healing process of the patient. In this study, we aimed to compare which of the DMSO-not removed and DMSO-removed samples showed the CD34 + SC amount more accurately as the SC amount determination method after the SC was dissolved after cryopreservation in patients who will undergo HSCT. A total of 22 patients were included in the study. All 22 patients were transplanted from frozen samples using DMSO. After the SC products were dissolved in a 37 °C water bath, they were washed 2 times and the amount of CD34+ SC was studied from the samples taken by removing DMSO and without removing DMSO. In the findings, the amounts of CD34+ SC studied with both methods were compared. The increase in the number and percentage of CD34+ SC after DMSO-removed was found to be statistically significant both in terms of difference and proportionally, and the calculated effect sizes also showed that the increase was clinically significant (Cohen's d is between 0.43 and 0.677). After thawing the frozen SCs of the patients who will undergo HSCT, the analysis of CD34+ SCs from which DMSO is removed provides a more accurate calculation of the CD34+ SC amount in the AP.
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3
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Meric N, Parmaksız A, Gulbas Z. Patients experienced serious adverse reactions within one hour of hematopoietic stem-cell infusion. Transfus Clin Biol 2023; 30:82-86. [PMID: 35987476 DOI: 10.1016/j.tracli.2022.08.141] [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: 03/21/2022] [Revised: 08/11/2022] [Accepted: 08/16/2022] [Indexed: 02/07/2023]
Abstract
METHODS SARs were examined occurred within 1 hour after initiating HSC product infusions in all HSCT done in Turkey's Anadolu Medical Center Hospital accredited for HSCTs between 2013 and 2015, targeting 315 patients. RESULTS SARs were carefully evaluated in this study based on a comparison of the amount of stem cells infused, age, frozen sample (FS) / non-frozen samples (NFS) between HSCs sources. Rate of SARs is significantly higher in FS infusions supports the hypothesis that DMSO plays an important role in the development of SAR. CONCLUSION The rate of SARs is significantly higher in infusions given using FSs confirms the hypothesis that the preservative agent DMSO plays an important role in the development of SAR. Our study provides guidance for future studies on the necessity of reducing the amount of DMSO in the HSCT product and using other alternative freezing agents instead of DMSO.
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Affiliation(s)
- Neslihan Meric
- Faculty of Engineering and Natural Sciences, Department of Molecular Biology and Genetics, Kütahya University of Health Sciences, Kütahya, Turkey.
| | - Ayhan Parmaksız
- Faculty of Medicine, Istanbul Health and Technology University, Istanbul, Turkey
| | - Zafer Gulbas
- Anadolu Health Center, Bone Marrow Transplantation Center, Kocaeli, Turkey
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4
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Huvarová L, Kořístek Z, Jelínek T, Černá L, Smejkalová J, Navrátil M, Grebeníček L, Tvrdá I, Michalíková M, Hájek R. Washing transplants with Sepax 2 reduces the incidence of side effects associated with autologous transplantation and increases patients' comfort. Transfusion 2021; 61:2430-2438. [PMID: 34197635 DOI: 10.1111/trf.16566] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 05/08/2021] [Accepted: 05/17/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND High-dose chemotherapy followed by autologous hematopoietic stem cell transplantation (ASCT) is routinely used in various hematologic malignancies. However, dimethylsulfoxide contained in cryopreserved grafts can cause adverse events (AEs). STUDY DESIGN AND METHODS Forty-three ASCTs were performed with Sepax 2 washed grafts between 7/2016 and 10/2019. The aim of this study was to determine whether washing out dimethyl sulfoxide (DMSO) from transplants using the Sepax 2 (S-100) device is safe and reduces the incidence of DMSO-associated AEs. RESULTS The washing procedure was automated and that resulted in the satisfactory recovery of total nucleated cells, CD34+ cells, and colony forming units of granulocyte and macrophages (85%, 80%, and 84%, medians). Time to engraftment of leukocytes, granulocytes, and platelets as well as the number of neutropenic days did not differ when compared to 20 consecutive ASCTs without washing. The AE occurrence was lower compared to unwashed grafts: 81% versus 78% during and shortly after grafts administration, 76% versus 69% in the following day. CONCLUSION We conclude that the washing of cryopreserved transplants using Sepax 2 was feasible with a high recovery of hematopoietic cells, did not influence time to engraftment, and resulted in the satisfactory reduction of AEs and improved tolerance of the procedure.
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Affiliation(s)
- Lucie Huvarová
- Department of Haematooncology, University Hospital Ostrava, Ostrava, Czech Republic.,Faculty of Science, University of Ostrava, Ostrava, Czech Republic
| | - Zdeněk Kořístek
- Department of Haematooncology, University Hospital Ostrava, Ostrava, Czech Republic.,Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - Tomáš Jelínek
- Department of Haematooncology, University Hospital Ostrava, Ostrava, Czech Republic.,Faculty of Science, University of Ostrava, Ostrava, Czech Republic.,Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - Lucie Černá
- Department of Haematooncology, University Hospital Ostrava, Ostrava, Czech Republic
| | - Jana Smejkalová
- Department of Haematooncology, University Hospital Ostrava, Ostrava, Czech Republic
| | - Milan Navrátil
- Department of Haematooncology, University Hospital Ostrava, Ostrava, Czech Republic.,Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - Lukáš Grebeníček
- Department of Haematooncology, University Hospital Ostrava, Ostrava, Czech Republic
| | - Ivana Tvrdá
- Department of Haematooncology, University Hospital Ostrava, Ostrava, Czech Republic
| | - Magda Michalíková
- Department of Haematooncology, University Hospital Ostrava, Ostrava, Czech Republic
| | - Roman Hájek
- Department of Haematooncology, University Hospital Ostrava, Ostrava, Czech Republic.,Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
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5
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Li A, Kusuma GD, Driscoll D, Smith N, Wall DM, Levine BL, James D, Lim R. Advances in automated cell washing and concentration. Cytotherapy 2021; 23:774-786. [PMID: 34052112 DOI: 10.1016/j.jcyt.2021.04.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 03/16/2021] [Accepted: 04/05/2021] [Indexed: 02/01/2023]
Abstract
The successful commercialization of cell therapies requires thorough planning and consideration of product quality, cost and scale of the manufacturing process. The implementation of automation can be central to a robust and reproducible manufacturing process at industrialized scales. There have been a number of wash-and-concentrate devices developed for cell manufacturing. These technologies have arisen from transfusion medicine, hematopoietic stem cell and biologics manufacturing where operating mechanisms are distinct from manual centrifugation. This review describes the historical origin and fundamental technologies underlying each currently available wash-and-concentrate device as well as their relative advantages and disadvantages in cell therapy applications. Understanding the specific attributes and limitations of these technologies is essential to optimizing cell therapy manufacturing.
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Affiliation(s)
- Anqi Li
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Australia; Department of Obstetrics and Gynaecology, Monash University, Melbourne, Australia
| | - Gina D Kusuma
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Australia; Department of Obstetrics and Gynaecology, Monash University, Melbourne, Australia
| | | | | | - Dominic M Wall
- Cell Therapies Pty Ltd, Melbourne, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | - Bruce L Levine
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Rebecca Lim
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Australia; Department of Obstetrics and Gynaecology, Monash University, Melbourne, Australia.
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6
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Awan M, Buriak I, Fleck R, Fuller B, Goltsev A, Kerby J, Lowdell M, Mericka P, Petrenko A, Petrenko Y, Rogulska O, Stolzing A, Stacey GN. Dimethyl sulfoxide: a central player since the dawn of cryobiology, is efficacy balanced by toxicity? Regen Med 2020; 15:1463-1491. [PMID: 32342730 DOI: 10.2217/rme-2019-0145] [Citation(s) in RCA: 85] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Dimethyl sulfoxide (DMSO) is the cryoprotectant of choice for most animal cell systems since the early history of cryopreservation. It has been used for decades in many thousands of cell transplants. These treatments would not have taken place without suitable sources of DMSO that enabled stable and safe storage of bone marrow and blood cells until needed for transfusion. Nevertheless, its effects on cell biology and apparent toxicity in patients have been an ongoing topic of debate, driving the search for less cytotoxic cryoprotectants. This review seeks to place the toxicity of DMSO in context of its effectiveness. It will also consider means of reducing its toxic effects, the alternatives to its use and their readiness for active use in clinical settings.
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Affiliation(s)
- Maooz Awan
- Institute for Liver & Digestive Health, UCL Division of Medicine, Royal Free Hospital, UCL, London, NW3 2PF, UK
| | - Iryna Buriak
- Institute for Problems of Cryobiology & Cryomedicine, National Academy of Sciences of Ukraine, Pereyaslavska 23, 61016, Kharkiv
| | - Roland Fleck
- Centre for Ultrastructural Imaging, Kings College London, London, SE1 1UL, UK
| | - Barry Fuller
- Department of Surgical Biotechnology, UCL Division of Surgery, Royal Free Hospital, UCL, London, NW3 2QG, UK
| | - Anatoliy Goltsev
- Institute for Problems of Cryobiology & Cryomedicine, National Academy of Sciences of Ukraine, Pereyaslavska 23, 61016, Kharkiv
| | - Julie Kerby
- Cell & Gene Therapy Catapult, 12th Floor Tower Wing, Guy's Hospital, Great Maze Pond, London, SE1 9RT, UK
| | - Mark Lowdell
- Centre for Cell, Gene & Tissue Therapy, Royal Free London NHS FT & UCL, London, NW3 2PF, UK
| | - Pavel Mericka
- Tissue Bank, University Hospital Hradec Kralové, Czech Republic
| | - Alexander Petrenko
- Institute for Problems of Cryobiology & Cryomedicine, National Academy of Sciences of Ukraine, Pereyaslavska 23, 61016, Kharkiv
| | - Yuri Petrenko
- Department of Biomaterials & Biophysical Methods, Institute of Experimental Medicine of the Czech Academy of Sciences, Prague, Czech Republic
| | - Olena Rogulska
- Institute for Problems of Cryobiology & Cryomedicine, National Academy of Sciences of Ukraine, Pereyaslavska 23, 61016, Kharkiv
| | - Alexandra Stolzing
- University of Loughborough, Centre for Biological Engineering, Loughborough University, Holywell Park, Loughborough, UK
| | - Glyn N Stacey
- International Stem Cell Banking Initiative, 2 High Street, Barley, Hertfordshire, SG8 8HZ
- Beijing Stem Cell Bank, Institute of Zoology, Chinese Academy of Sciences, 25–2 Beishuan West, Haidan District, 100190 Beijing, China
- Institute of Stem Cells & Regeneration, Chinese Academy of Sciences, Beijing 100101, China
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7
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Chen LN, Collins-Johnson N, Sapp N, Pickett A, West K, Stroncek DF, Panch SR. How do I structure logistic processes in preparation for outsourcing of cellular therapy manufacturing? Transfusion 2019; 59:2506-2518. [PMID: 31135995 DOI: 10.1111/trf.15349] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 05/01/2019] [Accepted: 05/01/2019] [Indexed: 12/12/2022]
Abstract
As cell and gene therapies (CGT) assume center stage in early-phase clinical trials for several acute and chronic diseases, there is heightened interest in the standardization and automation of manufacturing processes in preparation for commercialization. Toward this goal, a hybrid and oftentimes geographically separated model comprising regional cell procurement and infusion facilities and a centralized cell manufacturing unit is gaining traction in the field. Although CGT processing facilities in academic institutions are not involved directly in the manufacturing of these therapies, they must be prepared to collaborate with commercial or contract manufacturing organizations (CMOs) and be ready to address several supply-chain challenges that have emerged for autologous and allogeneic CGT. Academic center cell-processing facilities must handle many events up- and downstream of manufacturing such as donor screening, cell collection, product labeling, cryopreservation, transportation, and thaw infusion. These events merit closer evaluation in the context of multifacility manufacturing since standard procedures have yet to be established. Based on our institutional experience, we summarize logistical challenges encountered in the handling and distribution of CGT products in early phase studies, specifically those involving CMO (outsourced) manufacturing. We also make recommendations to standardize processes unique to the CGT supply chain, emphasizing the need to maintain needle-to-needle traceability from product collection to infusion. These guidelines will inform the development of more complex supply-chain models for larger-scale cell and gene therapeutics.
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Affiliation(s)
- Leonard N Chen
- Center for Cellular Engineering, Department of Transfusion Medicine, Clinical Center, National Institutes of Health, Bethesda, Maryland
| | - Naoza Collins-Johnson
- Center for Cellular Engineering, Department of Transfusion Medicine, Clinical Center, National Institutes of Health, Bethesda, Maryland
| | - Nasheda Sapp
- Center for Cellular Engineering, Department of Transfusion Medicine, Clinical Center, National Institutes of Health, Bethesda, Maryland
| | - Angela Pickett
- Center for Cellular Engineering, Department of Transfusion Medicine, Clinical Center, National Institutes of Health, Bethesda, Maryland
| | - Kamille West
- Blood Services Section, Department of Transfusion Medicine, Clinical Center, National Institutes of Health, Bethesda, Maryland
| | - David F Stroncek
- Center for Cellular Engineering, Department of Transfusion Medicine, Clinical Center, National Institutes of Health, Bethesda, Maryland
| | - Sandhya R Panch
- Center for Cellular Engineering, Department of Transfusion Medicine, Clinical Center, National Institutes of Health, Bethesda, Maryland
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8
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Rohner N, Passweg JR, Tsakiris DA, Halter JP, Heim D, Buser AS, Infanti L, Holbro A. The value of the post-thaw CD34+ count with and without DMSO removal in the setting of autologous stem cell transplantation. Transfusion 2018; 59:1052-1060. [PMID: 30556582 DOI: 10.1111/trf.15107] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 11/06/2018] [Accepted: 11/12/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND CD34+ cell count correlates with engraftment potency after autologous stem cell transplantation. Assessment of CD34+ mainly occurs after apheresis and before cryopreservation with dimethyl sulfoxide (DMSO). The influence of postthaw CD34+ cell numbers over time to engraftment is not well studied, and determination of postthaw CD34+ cell counts is challenging for a variety of reasons. The aim of this retrospective study was to systematically assess the value of postthaw CD34+ cell counts in autologous grafts with and without DMSO removal. STUDY DESIGN AND METHODS Between January 2008 and December 2015, 236 adult patients underwent a total of 292 autologous stem cell transplantations. Median age at transplantation was 56 years, and the main indication was multiple myeloma (60%). DMSO removal was done in 96 grafts (33%), either by centrifugation or by Sepax method. RESULTS Patients receiving grafts containing DMSO showed a significantly faster platelet (p = 0.02) and RBC (p = 0.001) engraftment. DMSO removal was not associated with fewer infusion-related adverse events. We observed a good correlation between CD34+ cell count after apheresis and CD34+ cell count after thawing/washing (r = 0.931). Ninety grafts (31%) showed a significant loss of viable CD34+ cells, which translated into a delayed engraftment. CONCLUSION DMSO removal was associated with delayed platelet and RBC engraftment without preventing adverse events. CD34+ cell enumeration after thawing remains difficult to perform, but grafts showing higher cell loss during cryopreservation and thawing are associated with slower engraftment. Prospective studies on the role of DMSO removal and postthaw CD34+ enumeration using defined protocols are needed.
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Affiliation(s)
- Nicolai Rohner
- Division of Hematology, University Hospital Basel, Switzerland
| | - Jakob R Passweg
- Division of Hematology, University Hospital Basel, Switzerland
| | | | - Jörg P Halter
- Division of Hematology, University Hospital Basel, Switzerland
| | - Dominik Heim
- Division of Hematology, University Hospital Basel, Switzerland
| | - Andreas S Buser
- Division of Hematology, University Hospital Basel, Switzerland.,Blood Transfusion Center, Swiss Red Cross, Basel, Switzerland
| | - Laura Infanti
- Division of Hematology, University Hospital Basel, Switzerland.,Blood Transfusion Center, Swiss Red Cross, Basel, Switzerland
| | - Andreas Holbro
- Division of Hematology, University Hospital Basel, Switzerland.,Blood Transfusion Center, Swiss Red Cross, Basel, Switzerland
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9
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Kollerup Madsen B, Hilscher M, Zetner D, Rosenberg J. Adverse reactions of dimethyl sulfoxide in humans: a systematic review. F1000Res 2018; 7:1746. [PMID: 31489176 PMCID: PMC6707402 DOI: 10.12688/f1000research.16642.1] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/31/2019] [Indexed: 08/09/2023] Open
Abstract
Background: Dimethyl sulfoxide (DMSO) has been used for medical treatment and as a pharmacological agent in humans since the 1960s. Today, DMSO is used mostly for cryopreservation of stem cells, treatment of interstitial cystitis, and as a penetrating vehicle for various drugs. Many adverse reactions have been described in relation to the use of DMSO, but to our knowledge, no overview of the existing literature has been made. Our aim was to conduct a systematic review describing the adverse reactions observed in humans in relation to the use of DMSO. Methods: This systematic review was reported according to the PRISMA-harms (Preferred Reporting Items for Systematic reviews and Meta-Analysis) guidelines. The primary outcome was any adverse reactions occurring in humans in relation to the use of DMSO. We included all original studies that reported adverse events due to the administration of DMSO, and that had a population of five or more. Results: We included a total of 109 studies. Gastrointestinal and skin reactions were the commonest reported adverse reactions to DMSO. Most reactions were transient without need for intervention. A relationship between the dose of DMSO given and the occurrence of adverse reactions was seen. Conclusions: DMSO may cause a variety of adverse reactions that are mostly transient and mild. The dose of DMSO plays an important role in the occurrence of adverse reactions. DMSO seems to be safe to use in small doses. Registration: PROSPERO CRD42018096117.
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Affiliation(s)
- Bennedikte Kollerup Madsen
- Department of Surgery, Center for Perioperative Optimization (CPO), Herlev Hospital, Herlev, 2730, Denmark
| | - Maria Hilscher
- Department of Surgery, Center for Perioperative Optimization (CPO), Herlev Hospital, Herlev, 2730, Denmark
| | - Dennis Zetner
- Department of Surgery, Center for Perioperative Optimization (CPO), Herlev Hospital, Herlev, 2730, Denmark
| | - Jacob Rosenberg
- Department of Surgery, Center for Perioperative Optimization (CPO), Herlev Hospital, Herlev, 2730, Denmark
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10
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Kollerup Madsen B, Hilscher M, Zetner D, Rosenberg J. Adverse reactions of dimethyl sulfoxide in humans: a systematic review. F1000Res 2018; 7:1746. [PMID: 31489176 PMCID: PMC6707402 DOI: 10.12688/f1000research.16642.2] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/31/2019] [Indexed: 12/14/2022] Open
Abstract
Background: Dimethyl sulfoxide (DMSO) has been used for medical treatment and as a pharmacological agent in humans since the 1960s. Today, DMSO is used mostly for cryopreservation of stem cells, treatment of interstitial cystitis, and as a penetrating vehicle for various drugs. Many adverse reactions have been described in relation to the use of DMSO, but to our knowledge, no overview of the existing literature has been made. Our aim was to conduct a systematic review describing the adverse reactions observed in humans in relation to the use of DMSO. Methods: This systematic review was reported according to the PRISMA-harms (Preferred Reporting Items for Systematic reviews and Meta-Analysis) guidelines. The primary outcome was any adverse reactions occurring in humans in relation to the use of DMSO. We included all original studies that reported adverse events due to the administration of DMSO, and that had a population of five or more. Results: We included a total of 109 studies. Gastrointestinal and skin reactions were the commonest reported adverse reactions to DMSO. Most reactions were transient without need for intervention. A relationship between the dose of DMSO given and the occurrence of adverse reactions was seen. Conclusions: DMSO may cause a variety of adverse reactions that are mostly transient and mild. The dose of DMSO plays an important role in the occurrence of adverse reactions. DMSO seems to be safe to use in small doses. Registration: PROSPERO
CRD42018096117.
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Affiliation(s)
- Bennedikte Kollerup Madsen
- Department of Surgery, Center for Perioperative Optimization (CPO), Herlev Hospital, Herlev, 2730, Denmark
| | - Maria Hilscher
- Department of Surgery, Center for Perioperative Optimization (CPO), Herlev Hospital, Herlev, 2730, Denmark
| | - Dennis Zetner
- Department of Surgery, Center for Perioperative Optimization (CPO), Herlev Hospital, Herlev, 2730, Denmark
| | - Jacob Rosenberg
- Department of Surgery, Center for Perioperative Optimization (CPO), Herlev Hospital, Herlev, 2730, Denmark
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11
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Halldorsdottir AM, Atladottir S, Thorsteinsdottir MA, Arnason NA, Runarsson G, Jonsson T, Sigurjonsson OE, Reykdal S. To Wash or Not to Wash? Comparison of Patient Outcome after Infusion of Cryopreserved Autologous Hematopoietic Stem Cells before and after the Replacement of Manual Washing by Bedside Thawing. Acta Haematol 2018; 140:169-175. [PMID: 30300877 DOI: 10.1159/000492741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 08/04/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Prior to infusion, cryopreserved autologous peripheral blood stem cell (auto-PBSC) grafts can either be thawed at the bedside or thawed and washed at the laboratory. At our center, manual washing of grafts prior to infusion was discontinued in April 2012 and bedside thawing was implemented. METHODS This study compares the outcomes of two patient groups who received auto-PBSC either after post-thaw washing (n = 84) or bedside thawing (n = 83). RESULTS No life-threatening infusion-related side effects were reported in either group. There was no significant difference in the mean CD34+ cells/kg dose of infused auto-PBSC in the two groups (p = 0.41), nor in the number of days to neutrophils > 0.5 × 10(9)/L (p = 0.14), days to platelets > 20 × 10(9)/L (p = 0.64), or days to platelets > 50 × 10(9)/L (p = 0.62) after transplant. There was also no difference in the number of days on total parenteral nutrition (p = 0.69), days on G-CSF therapy (p = 0.48), or days with fever (p = 0.73). Finally, there was no significant difference in the number of red cell units transfused (p = 0.32), or platelet units transfused (p = 0.94) after the transplant. One-hundred-day mortality was identical in the two groups (2.4%). CONCLUSION Both thawing procedures are safe and result in acceptable engraftment and patient outcomes.
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Affiliation(s)
- Anna Margret Halldorsdottir
- The Blood Bank, Landspítali, The National University Hospital of Iceland, Reykjavik, Iceland
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Sveinlaug Atladottir
- Department of Hematology, Landspítali, The National University Hospital of Iceland, Reykjavik, Iceland
| | | | - Niels A Arnason
- The Blood Bank, Landspítali, The National University Hospital of Iceland, Reykjavik, Iceland
| | - Gudmundur Runarsson
- Department of Hematology, Landspítali, The National University Hospital of Iceland, Reykjavik, Iceland
| | - Torbjorn Jonsson
- The Blood Bank, Landspítali, The National University Hospital of Iceland, Reykjavik, Iceland
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Olafur E Sigurjonsson
- The Blood Bank, Landspítali, The National University Hospital of Iceland, Reykjavik, Iceland
- School of Science and Engineering, Reykjavik University, Reykjavik, Iceland
| | - Sigrun Reykdal
- Department of Hematology, Landspítali, The National University Hospital of Iceland, Reykjavik, Iceland
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12
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Automated washing of long-term cryopreserved peripheral blood stem cells promotes cell viability and preserves CD34+ cell numbers. Bone Marrow Transplant 2018; 53:1225-1227. [PMID: 29703970 DOI: 10.1038/s41409-018-0192-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 03/26/2018] [Accepted: 03/28/2018] [Indexed: 12/15/2022]
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13
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Abonnenc M, Pesse B, Tissot JD, Barelli S, Lion N. Automatic washing of thawed haematopoietic progenitor cell grafts: a preclinical evaluation. Vox Sang 2017; 112:367-378. [DOI: 10.1111/vox.12503] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 12/21/2016] [Accepted: 01/26/2017] [Indexed: 01/07/2023]
Affiliation(s)
- M. Abonnenc
- Laboratoire R&D Produits; Transfusion Interrégionale CRS; Epalinges Switzerland
| | - B. Pesse
- Laboratoire R&D Produits; Transfusion Interrégionale CRS; Epalinges Switzerland
| | - J.-D. Tissot
- Laboratoire R&D Produits; Transfusion Interrégionale CRS; Epalinges Switzerland
| | - S. Barelli
- Laboratoire R&D Produits; Transfusion Interrégionale CRS; Epalinges Switzerland
| | - N. Lion
- Laboratoire R&D Produits; Transfusion Interrégionale CRS; Epalinges Switzerland
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Otrock ZK, Sempek DS, Carey S, Grossman BJ. Adverse events of cryopreserved hematopoietic stem cell infusions in adults: a single-center observational study. Transfusion 2017; 57:1522-1526. [PMID: 28301051 DOI: 10.1111/trf.14072] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Revised: 01/04/2017] [Accepted: 01/13/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND Autologous hematopoietic stem cell (HSC) transplantation has been used for almost three decades for the management of malignant hematologic diseases and some solid tumors. Dimethyl sulfoxide (DMSO) is used as a cryoprotective agent for hematopoietic progenitor cells (HPCs) collected by apheresis (HPC-A). We evaluated the factors contributing to the occurrence of adverse events (AEs) of cryopreserved HPC-A infusion. STUDY DESIGN AND METHODS Between January 2009 and June 2014, a total of 1269 (1191 patients) consecutive HPC-A infusions were given to adult patients undergoing autologous HSC transplantation at Barnes-Jewish Hospital. Only infusions on the first day of transplant were included in the analysis. RESULTS AEs were reported in 480 (37.8%) infusions. The most common AEs were facial flushing in 189 (39.4%) infusions, nausea and/or vomiting in 183 (38.1%) infusions, hypoxia requiring oxygen in 139 (29%) infusions, and chest tightness in 80 (16.7%) infusions. Multivariate analysis using logistic regression showed that female sex (odds ratio [OR], 1.78; 95% confidence interval [CI], 1.40-2.26; p < 0.0001), diagnosis other than multiple myeloma (OR, 1.44; 95% CI, 1.12-1.84; p = 0.004), larger volume of infusion per body weight (OR, 1.66; 95% CI, 1.29-2.15; p < 0.0001), and number of granulocytes infused per body weight (OR, 1.30; 95% CI, 1.01-1.67; p = 0.042) were significant predictors of occurrence of AEs during infusion. CONCLUSION AEs due to HPC-A infusion occurred in more than one-third of patients. Interventions need to be instituted to reduce AEs and thus improve the safety of HPC-A infusion. Many of these toxicities can be attributed to DMSO, and this is reflected in the volume of infusion. It might be warranted to consider implementing DMSO-reducing protocols before infusion.
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Affiliation(s)
- Zaher K Otrock
- Department of Pathology and Immunology, Barnes-Jewish Hospital, Washington University, St Louis, Missouri
| | - Diane S Sempek
- Department of Pathology and Immunology, Barnes-Jewish Hospital, Washington University, St Louis, Missouri
| | - Sherry Carey
- Department of Pathology and Immunology, Barnes-Jewish Hospital, Washington University, St Louis, Missouri
| | - Brenda J Grossman
- Department of Pathology and Immunology, Barnes-Jewish Hospital, Washington University, St Louis, Missouri
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Boulanger F, Decot V, Bulliard G, Calmels B, Giraud C, Lacassagne MN, Magnani A, Pouthier F, Thibert JB, Tirefort Y, Yakoub-Agha I, Baudoux E. Modalités de préparation, cryopréservation, décongélation des cellules souches hématopoïétiques et précautions pour infusion au patient : recommandations de la Société francophone de greffe de moelle et de thérapie cellulaire (SFGM-TC). Bull Cancer 2016; 103:S267-S272. [DOI: 10.1016/j.bulcan.2016.09.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Accepted: 09/01/2016] [Indexed: 11/29/2022]
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Morris C, de Wreede L, Scholten M, Brand R, van Biezen A, Sureda A, Dickmeiss E, Trneny M, Apperley J, Chiusolo P, van Imhoff GW, Lenhoff S, Martinelli G, Hentrich M, Pabst T, Onida F, Quinn M, Kroger N, de Witte T, Ruutu T. Should the standard dimethyl sulfoxide concentration be reduced? Results of a European Group for Blood and Marrow Transplantation prospective noninterventional study on usage and side effects of dimethyl sulfoxide. Transfusion 2014; 54:2514-22. [DOI: 10.1111/trf.12759] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Revised: 02/18/2014] [Accepted: 02/20/2014] [Indexed: 12/30/2022]
Affiliation(s)
- Curly Morris
- Centre for Cancer Research and Cell Biology; Queen's University of Belfast; Belfast UK
| | - Liesbeth de Wreede
- EBMT, Department of Medical Statistics and Bioinformatics; Leiden University Medical Center; Leiden The Netherlands
| | - Marijke Scholten
- EBMT, Department of Medical Statistics and Bioinformatics; Leiden University Medical Center; Leiden The Netherlands
| | - Ronald Brand
- EBMT, Department of Medical Statistics and Bioinformatics; Leiden University Medical Center; Leiden The Netherlands
| | - Anja van Biezen
- EBMT, Department of Medical Statistics and Bioinformatics; Leiden University Medical Center; Leiden The Netherlands
| | - Anna Sureda
- Department of Haematology, Addenbrooke's Hospital; Cambridge University; Cambridge UK
| | - Ebbe Dickmeiss
- Cell Therapy Section, Department of Clinical Immunology; Rigshospitalet; Copenhagen Denmark
| | - Marek Trneny
- Charles University Hospital; Prague Czech Republic
| | - Jane Apperley
- Department of Haematology; Hammersmith Hospital; London UK
| | | | - Gustaaf W. van Imhoff
- Department of Hematology; University Medical Center Groningen; Groningen The Netherlands
| | - Stig Lenhoff
- Department of Hematology; University Hospital; Lund Sweden
| | | | | | | | - Francesco Onida
- Department of Hematology and Oncology; University of Milan; Milan Italy
| | - Michael Quinn
- Department of Haematology; Belfast City Hospital; Belfast UK
| | - Nicolaus Kroger
- Department of Stem Cell Transplantation; University Hospital Hamburg-Eppendorf; Hamburg Germany
| | - Theo de Witte
- Department of Hematology; Radboud University Nijmegen Medical Centre; Nijmegen The Netherlands
| | - Tapani Ruutu
- Department of Medicine; Helsinki University Central Hospital; Helsinki Finland
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Calmels B, Drezet A, Huynh C, Autret A, Stoppa AM, Bouabdallah R, Coso D, Malenfant C, Lemarié C, Chabannon C. Automated washing of autologous hematopoietic stem cell grafts after thawing does not impair engraftment. Bone Marrow Transplant 2014; 49:1127-8. [PMID: 24887385 DOI: 10.1038/bmt.2014.111] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- B Calmels
- 1] Centre de Thérapie Cellulaire, Département de Biologie du Cancer, Institut Paoli-Calmettes, Marseille, France [2] Inserm CBT-510, Centre d'Investigations Cliniques en Biothérapie, Marseille, France [3] Inserm UMR 1068, CNRS UMR 7258, AMU 105, Centre de Recherche en Cancérologie de Marseille, Marseille, France
| | - A Drezet
- Inserm UMR 1068, CNRS UMR 7258, AMU 105, Centre de Recherche en Cancérologie de Marseille, Marseille, France
| | - C Huynh
- Centre de Thérapie Cellulaire, Département de Biologie du Cancer, Institut Paoli-Calmettes, Marseille, France
| | - A Autret
- Unité de Biostatistique et de Méthodologie, Département de la Recherche Clinique et de l'Innovation (DRCI), Institut Paoli-Calmettes, Marseille, France
| | - A-M Stoppa
- Département d'Onco-Hématologie, Institut Paoli-Calmettes, Marseille, France
| | - R Bouabdallah
- Département d'Onco-Hématologie, Institut Paoli-Calmettes, Marseille, France
| | - D Coso
- Département d'Onco-Hématologie, Institut Paoli-Calmettes, Marseille, France
| | - C Malenfant
- Centre de Thérapie Cellulaire, Département de Biologie du Cancer, Institut Paoli-Calmettes, Marseille, France
| | - C Lemarié
- 1] Centre de Thérapie Cellulaire, Département de Biologie du Cancer, Institut Paoli-Calmettes, Marseille, France [2] Inserm CBT-510, Centre d'Investigations Cliniques en Biothérapie, Marseille, France
| | - C Chabannon
- 1] Centre de Thérapie Cellulaire, Département de Biologie du Cancer, Institut Paoli-Calmettes, Marseille, France [2] Inserm CBT-510, Centre d'Investigations Cliniques en Biothérapie, Marseille, France [3] Inserm UMR 1068, CNRS UMR 7258, AMU 105, Centre de Recherche en Cancérologie de Marseille, Marseille, France [4] Aix-Marseille Université (AMU), Marseille, France
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Shu Z, Heimfeld S, Gao D. Hematopoietic SCT with cryopreserved grafts: adverse reactions after transplantation and cryoprotectant removal before infusion. Bone Marrow Transplant 2013; 49:469-76. [PMID: 24076548 DOI: 10.1038/bmt.2013.152] [Citation(s) in RCA: 129] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Accepted: 05/15/2013] [Indexed: 12/23/2022]
Abstract
Transplantation of hematopoietic stem cells (HSCs) has been successfully developed as a part of treatment protocols for a large number of clinical indications, and cryopreservation of both autologous and allogeneic sources of HSC grafts is increasingly being used to facilitate logistical challenges in coordinating the collection, processing, preparation, quality control testing and release of the final HSC product with delivery to the patient. Direct infusion of cryopreserved cell products into patients has been associated with the development of adverse reactions, ranging from relatively mild symptoms to much more serious, life-threatening complications, including allergic/gastrointestinal/cardiovascular/neurological complications, renal/hepatic dysfunctions, and so on. In many cases, the cryoprotective agent (CPA) used-which is typically dimethyl sulfoxide (DMSO)-is believed to be the main causal agent of these adverse reactions and thus many studies recommend depletion of DMSO before cell infusion. In this paper, we will briefly review the history of HSC cryopreservation, the side effects reported after transplantation, along with advances in strategies for reducing the adverse reactions, including methods and devices for removal of DMSO. Strategies to minimize adverse effects include medication before and after transplantation, optimizing the infusion procedure, reducing the DMSO concentration or using alternative CPAs for cryopreservation and removing DMSO before infusion. For DMSO removal, besides the traditional and widely applied method of centrifugation, new approaches have been explored in the past decade, such as filtration by spinning membrane, stepwise dilution-centrifugation using rotating syringe, diffusion-based DMSO extraction in microfluidic channels, dialysis and dilution-filtration through hollow-fiber dialyzers and some instruments (CytoMate, Sepax S-100, Cobe 2991, microfluidic channels, dilution-filtration system, etc.) as well. However, challenges still remain: development of the optimal (fast, safe, simple, automated, controllable, effective and low cost) methods and devices for CPA removal with minimum cell loss and damage remains an unfilled need.
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Affiliation(s)
- Z Shu
- Department of Mechanical Engineering and Department of Bioengineering, University of Washington, Seattle, WA, USA
| | - S Heimfeld
- Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - D Gao
- Department of Mechanical Engineering and Department of Bioengineering, University of Washington, Seattle, WA, USA
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Scerpa MC, Rossi C, Daniele N, Lanti A, Adorno G, Picardi A, Arcese W, Amadori S, Isacchi G, Zinno F. A new system for quality control in hematopoietic progenitor cell units before reinfusion in autologous transplant. Transfusion 2013; 54:522-31. [PMID: 23789937 DOI: 10.1111/trf.12307] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Revised: 05/09/2013] [Accepted: 05/10/2013] [Indexed: 12/29/2022]
Abstract
BACKGROUND In our Center, the cell viability, the integrity of the bag, and the clonogenic assay were evaluated before the reinfusion of hematopoietic progenitor cells-apheresis (HPC-A). This quality control (QC) should be made 14 days before the reinfusion to the patient to have the result of the functional test on the proliferative capacity of hematopoietic progenitors. STUDY DESIGN AND METHODS This study was designed to assess the potential of an automatic cell counting system (NucleoCounter NC-3000, ChemoMetec) in our clinical routine as a support of the clonogenic assay and the cytofluorimetric analysis for the QC of the cryopreserved HPC-A. The cell viability was evaluated by flow cytometry using the modified International Society of Hematotherapy and Graft Engineering protocol. The proliferative potential was assessed by specific clonogenic tests using a commercial medium. Furthermore, we evaluated the cellular functionality with NucleoCounter NC-3000, by using two protocols: "vitality assay" and "mitochondrial potential assay." RESULTS The evaluation of the total nucleated cells in preapoptosis measured by 5,5,6,6-tetrachloro-1,1,3,3-tetraethylbenzimidazol-carbocyanine iodide (JC-1) assay showed a negative correlation (r=-0.43) with the total number of colonies (colony-forming unit [CFU]-granulocyte-macrophage progenitors plus burst-forming unit-erythroid progenitors plus CFU-granulocyte, erythroid, macrophage, megakaryocyte progenitors) obtained after seeding of 50 × 10(6) /L viable total nucleated cells. We observed a significant difference (p<0.0001) comparing the median number of colonies (166.70; SD, ± 136.36) obtained with a value of JC-1 less than 30% to the number of colonies (61.75; SD, ± 59.76) obtained with a value of JC-1 more than 30%. CONCLUSION The evaluation of cell functionality by the use of the NucleoCounter NC-3000 is in agreement with results from clonogenic assay and can be considered an effective alternative in the routine laboratory.
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Affiliation(s)
- Maria Cristina Scerpa
- Cryolab Center of Biotechnology and Cryobiology, Immunohematology Section, SIMT, Department of Hematology, Tor Vergata University, Rome, Italy; Rome Transplant Network, Department of Hematology, Tor Vergata University, Rome, Italy
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Tran CA, Torres-Coronado M, Gardner A, Gu A, Vu H, Rao A, Cao LF, Ahmed A, Digiusto D. Optimized processing of growth factor mobilized peripheral blood CD34+ products by counterflow centrifugal elutriation. Stem Cells Transl Med 2012. [PMID: 23197821 DOI: 10.5966/sctm.2011-0062] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Cell separation by counterflow centrifugal elutriation has been described for the preparation of monocytes for vaccine applications, but its use in other current good manufacturing practice (cGMP) operations has been limited. In this study, growth factor-mobilized peripheral blood progenitor cell products were collected from healthy donors and processed by elutriation using a commercial cell washing device. Fractions were collected for each product as per the manufacturer's instructions or using a modified protocol developed in our laboratory. Each fraction was analyzed for cell count, viability, and blood cell differential. Our data demonstrate that, using standard elutriation procedures, >99% of red blood cells and platelets were removed from apheresis products with high recoveries of total white blood cells and enrichment of CD34+ cells in two of five fractions. With modification of the basic protocol, we were able to collect all of the CD34+ cells in a single fraction. The CD34-enriched fractions were formulated, labeled with a ferromagnetic antibody to CD34, washed using the Elutra device, and transferred directly to a magnetic bead selection device for further purification. CD34+ cell purities from the column were extremely high (98.7 ± 0.9%), and yields were typical for the device (55.7 ± 12.3%). The processes were highly automated and closed from receipt of the apheresis product through formulation of target-enriched cell fractions. Thus, elutriation is a feasible method for the initial manipulations associated with primary blood cell therapy products and supports cGMP and current good tissue practice-compliant cell processing.
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Affiliation(s)
- Chy-Anh Tran
- Beckman Research Institute of the City of Hope, Duarte, California CA 91010, USA
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21
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Kirana S, Stratmann B, Prante C, Prohaska W, Koerperich H, Lammers D, Gastens MH, Quast T, Negrean M, Stirban OA, Nandrean SG, Götting C, Minartz P, Kleesiek K, Tschoepe D. Autologous stem cell therapy in the treatment of limb ischaemia induced chronic tissue ulcers of diabetic foot patients. Int J Clin Pract 2012; 66:384-93. [PMID: 22284892 DOI: 10.1111/j.1742-1241.2011.02886.x] [Citation(s) in RCA: 97] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND AND AIM Despite improvements in surgical revascularisation, limitations like anatomical factors or atherosclerosis limit the success of revascularisation in diabetic patients with critical limb ischaemia. Stem cells were shown to improve microcirculation in published studies. The aim of this study was to evaluate safety, feasibility and efficacy of transplantation of bone marrow derived cellular products regarding improvement in microcirculation and lowering of amputation rate. METHODS Bone marrow mononuclear cells (BMCs) in comparison with expanded bone marrow cells enriched in CD90+ cells ('tissue repair cells', TRCs) were used in the treatment of diabetic ulcers to induce revascularisation. Diabetic foot patients with critical limb ischaemia without option for surgical or interventional revascularisation were eligible. Parameters examined were ABI, TcPO(2) , reactive hyperaemia and angiographic imaging before and after therapy. RESULTS Of 30 patients included in this trial, 24 were randomised to receive either BMCs or TRCs. The high number of drop-outs in the control group (4 of 6) led to exclusion from evaluation. A total of 22 patients entered treatment; one patient in the TRC group and two in the BMC group did not show wound healing during follow up, one patient in each treatment group died before reaching the end of the study; one after having achieved wound healing (BMC group), the other one without having achieved wound healing (TRC group). Thus, 18 patients showed wound healing after 45 weeks. The total number of applicated cells was 3.8 times lower in the TRC group, but TRC patients received significantly higher amounts of CD90+ cells. Improvement in microvascularisation was detected in some, but not all patients by angiography, TcPO(2) improved significantly compared with baseline in both therapy groups. CONCLUSION The transplantation of BMCs as well as TRCs proved to be safe and feasible. Improvements of microcirculation and complete wound healing were observed in the transplant groups.
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Affiliation(s)
- S Kirana
- Diabetes Centre, Heart and Diabetes Centre NRW, Ruhr University Bochum, Germany
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Akkök ÇA, Liseth K, Melve GK, Ersvær E, Hervig T, Bruserud Ø. Is there a scientific basis for a recommended standardization of collection and cryopreservation of peripheral blood stem cell grafts? Cytotherapy 2011; 13:1013-24. [DOI: 10.3109/14653249.2011.574117] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Cox MA, Kastrup J, Hrubiško M. Historical perspectives and the future of adverse reactions associated with haemopoietic stem cells cryopreserved with dimethyl sulfoxide. Cell Tissue Bank 2011; 13:203-15. [DOI: 10.1007/s10561-011-9248-2] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2010] [Accepted: 02/25/2011] [Indexed: 01/13/2023]
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Martín-Henao GA, Resano PM, Villegas JMS, Manero PP, Sánchez JM, Bosch MP, Codins AE, Bruguera MS, Infante LR, Oyarzabal AP, Soldevila RN, Caiz DC, Bosch LM, Barbeta EC, Ronda JRG. Adverse reactions during transfusion of thawed haematopoietic progenitor cells from apheresis are closely related to the number of granulocyte cells in the leukapheresis product. Vox Sang 2010; 99:267-73. [DOI: 10.1111/j.1423-0410.2010.01341.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Akkök ÇA, Liseth K, Hervig T, Ryningen A, Bruserud Ø, Ersvær E. Use of different DMSO concentrations for cryopreservation of autologous peripheral blood stem cell grafts does not have any major impact on levels of leukocyte-and platelet-derived soluble mediators. Cytotherapy 2009; 11:749-60. [DOI: 10.3109/14653240902980443] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Akkök CA, Holte MR, Tangen JM, Ostenstad B, Bruserud O. Hematopoietic engraftment of dimethyl sulfoxide-depleted autologous peripheral blood progenitor cells. Transfusion 2008; 49:354-61. [PMID: 18980622 DOI: 10.1111/j.1537-2995.2008.01949.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Autologous stem cell transplantation with cryopreserved autografts is a prerequisite for high-dose chemotherapy in treatment of several malignancies. Adverse effects due to the cryoprotectant dimethyl sulfoxide (DMSO) vary from mild to severe. DMSO-associated adverse effects can be reduced by DMSO depletion before autograft infusion. The aim was to investigate whether DMSO depletion by manual single wash reduced frequency of adverse effects or had detrimental effects on the engraftment potential of peripheral blood progenitor cell (PBPC) autografts. STUDY DESIGN AND METHODS Ten percent DMSO was used to cryopreserve PBPC autografts for a total of 53 patients with multiple myeloma (n = 41), non-Hodgkin's lymphoma (n = 8), amyloidosis (n = 3), and polyneuropathy, organomegaly, endocrinopathy, M protein, and skin changes (POEMS) syndrome (n = 1). After high-dose chemotherapy, 34 patients received unmanipulated autografts, whereas for 19 patients the autografts were manually washed before stem cell infusion. Adverse effects after the infusion as well as neutrophil (neutrophil count >0.5 x 10(9)/L) and platelet (PLT) engraftment (PLT count >20 x 10(9)/L) for these two groups were compared. RESULTS DMSO depletion reduced the frequency of adverse effects significantly. Patients transplanted with DMSO-depleted autografts had similar neutrophil engraftment time as patients receiving unmanipulated autografts. PLT engraftment time, however, was significantly prolonged and PLT transfusion requirements significantly increased for patients receiving DMSO-depleted autografts, even though the numbers of infused CD34+ cells per kg did not differ between the groups. CONCLUSIONS DMSO depletion through a manual single wash is a time-consuming procedure that reduces adverse effects. Although the procedure leads to an increase of 2 days in PLT engraftment time, it can be recommended for selected patients with high risk of serious DMSO toxicity.
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Affiliation(s)
- Ciğdem A Akkök
- Department of Immunology and Transfusion Medicine, the Centre of Clinical Research, Ullevaal University Hospital, Oslo, Norway.
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Akkök ÇA, Liseth K, Nesthus I, Løkeland T, Tefre K, Bruserud Ø, Abrahamsen JF. Autologous peripheral blood progenitor cells cryopreserved with 5 and 10 percent dimethyl sulfoxide alone give comparable hematopoietic reconstitution after transplantation. Transfusion 2008; 48:877-83. [DOI: 10.1111/j.1537-2995.2008.01648.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Giancola R, Olioso P, Di Riti M, Capone A, Contento A, Pompetti F, Iacone A. Evaluation of an automated closed fluid management device for processing expanded cytokine-induced killer cells to use in immunotherapy programs for cancer. Transfusion 2008; 48:629-39. [DOI: 10.1111/j.1537-2995.2007.01587.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Gastens MH, Goltry K, Prohaska W, Tschöpe D, Stratmann B, Lammers D, Kirana S, Götting C, Kleesiek K. Good manufacturing practice-compliant expansion of marrow-derived stem and progenitor cells for cell therapy. Cell Transplant 2008; 16:685-96. [PMID: 18019358 DOI: 10.3727/000000007783465172] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Ex vivo expansion is being used to increase the number of stem and progenitor cells for autologous cell therapy. Initiation of pivotal clinical trials testing the efficacy of these cells for tissue repair has been hampered by the challenge of assuring safe and high-quality cell production. A strategy is described here for clinical-scale expansion of bone marrow (BM)-derived stem cells within a mixed cell population in a completely closed process from cell collection through postculture processing using sterile connectable devices. Human BM mononuclear cells (BMMNC) were isolated, cultured for 12 days, and washed postharvest using either standard open procedures in laminar flow hoods or using automated closed systems. Conditions for these studies were similar to long-term BM cultures in which hematopoietic and stromal components are cultured together. Expansion of marrow-derived stem and progenitor cells was then assessed. Cell yield, number of colony forming units (CFU), phenotype, stability, and multilineage differentiation capacity were compared from the single pass perfusion bioreactor and standard flask cultures. Purification of BMMNC using a closed Ficoll gradient process led to depletion of 98% erythrocytes and 87% granulocytes, compared to 100% and 70%, respectively, for manual processing. After closed system culture, mesenchymal progenitors, measured as CD105+CD166+CD14-CD45- and fibroblastic CFU, expanded 317- and 364-fold, respectively, while CD34+ hematopoietic progenitors were depleted 10-fold compared to starting BMMNC. Cultured cells exhibited multilineage differentiation by displaying adipogenic, osteogenic, and endothelial characteristics in vitro. No significant difference was observed between manual and bioreactor cultures. Automated culture and washing of the cell product resulted in 181 x 10(6) total cells that were viable and contained fibroblastic CFU for at least 24 h of storage. A combination of closed, automated technologies enabled production of good manufacturing practice (GMP)-compliant cell therapeutics, ready for use within a clinical setting, with minimal risk of microbial contamination.
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Affiliation(s)
- Martin H Gastens
- Institut für Laboratoriums- und Transfusionsmedizin, Herz- und Diabeteszentrum Nordrhein-Westfalen, Universitätsklinik der Ruhr-Universität Bochum, 32545 Bad Oeynhausen, Germany.
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DiGiusto DL, Cooper LJN. Preparing clinical grade Ag-specific T cells for adoptive immunotherapy trials. Cytotherapy 2008; 9:613-29. [PMID: 17943498 DOI: 10.1080/14653240701650320] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The production of clinical-grade T cells for adoptive immunotherapy has evolved from the ex vivo numerical expansion of tumor-infiltrating lymphocytes to sophisticated bioengineering processes often requiring cell selection, genetic modification and other extensive tissue culture manipulations, to produce desired cells with improved therapeutic potential. Advancements in understanding the biology of lymphocyte signaling, activation, homing and sustained in vivo proliferative potential have redefined the strategies used to produce T cells suitable for clinical investigation. When combined with new technical methods in cell processing and culturing, the therapeutic potential of T cells manufactured in academic centers has improved dramatically. Paralleling these technical achievements in cell manufacturing is the development of broadly applied regulatory standards that define the requirements for the clinical implementation of cell products with ever-increasing complexity. In concert with academic facilities operating in compliance with current good manufacturing practice, the prescribing physician can now infuse T cells with a highly selected or endowed phenotype that has been uniformly manufactured according to standard operating procedures and that meets federal guidelines for quality of investigational cell products. In this review we address salient issues related to the technical, immunologic, practical and regulatory aspects of manufacturing these advanced T-cell products for clinical use.
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Affiliation(s)
- D L DiGiusto
- Division of Hematology and Hematopoietic Cell Transplantation, Beckman Research Institute and City of Hope National Medical Center, Duarte, CA 91010, USA.
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Cordoba R, Arrieta R, Kerguelen A, Hernandez-Navarro F. The occurrence of adverse events during the infusion of autologous peripheral blood stem cells is related to the number of granulocytes in the leukapheresis product. Bone Marrow Transplant 2007; 40:1063-7. [PMID: 17906706 DOI: 10.1038/sj.bmt.1705861] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Toxicity related to autologous PBSC infusion is well known and traditionally attributed to the presence of DMSO as cryoprotectant. But despite DMSO depletion, adverse events continue appearing. We have conducted a retrospective study to determine the incidence of adverse events related to the PBSC infusion in a large series of 144 patients. Adverse effects were observed in 67.36% of patients, although most of them were of grade 1 or 2. The adverse events most frequently reported were allergic reactions, followed by general, gastrointestinal and respiratory symptoms. In the univariate analysis, age (P=0.01), the volume infused (P=0.005), the amount of DMSO (P=0.008), the total nucleated cells (P=0.002), the total number of granulocytes (P=0.000001) and clumping (P=0.000001) were associated with the occurrence of adverse events. In the multivariate analysis, two protective factors, age (P=0.05) and sex (P=0.004), and two risk factors, the number of granulocytes, with a relative risk of 1.18 (95% confidence interval, 1.06-1.31) (P=0.002), and clumping, with an relative risk of 1.94 (95% confidence interval, 1.15-3.29) (P=0.013), were identified. The best cutoff point for the prediction of the occurrence of adverse events, with a sensitivity of 47% and specificity of 89%, was 6.065 x 10(9) granulocytes.
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Affiliation(s)
- R Cordoba
- Bone Marrow Transplantation Unit, Hospital Universitario La Paz, Madrid, Spain.
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Tran CA, Burton L, Russom D, Wagner JR, Jensen MC, Forman SJ, DiGiusto DL. Manufacturing of large numbers of patient-specific T cells for adoptive immunotherapy: an approach to improving product safety, composition, and production capacity. J Immunother 2007; 30:644-54. [PMID: 17667528 DOI: 10.1097/cji.0b013e318052e1f4] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
We have developed an innovative system for ex vivo processing of patient-specific cell products to produce large numbers of T-lymphocytes in support of phase 2 adoptive immunotherapy trials for hematologic malignancies. Extensive efforts were undertaken to close the cell processing system to improve the safety profile of the process and comply with new federal regulations regarding cell and tissue processing. Our results demonstrate that apheresis products can be processed in a closed system (Cytomate) with similar yields (approximately 4 x 10(9) mononuclear cells/apheresis) and recoveries (approximately 60% of starting mononuclear cells) to manual cell processing. Cells processed with this system could be cryopreserved for up to 5 months without significant loss of recovery or viability. Additionally, we have evaluated the use of gas permeable bags and developed perfusion bioreactor protocols in which T cells can be rapidly produced in excess of 10(10) viable cells per liter of culture. Using similar methods for upfront processing, we have also developed methods for positive selection and ex vivo culture of CD4+ T cells that result in 200 to 800-fold expansion of fresh or cryopreserved samples. T cells produced in these systems were shown to retain activation-induced cytolytic capability and TH1/TH2 cytokine production as a measure of biologic potency. These new methods allow for more efficient production multiple patient-specific products by satisfying the basic tenants of safety and efficacy required for early phase clinical trials of cell products.
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Affiliation(s)
- Chy-Anh Tran
- Division of Hematology/Hematopoietic Cell Transplantation, City of Hope National Medical Center and Beckman Research Institute, Duarte, CA 91010, USA
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Calmels B, Lemarié C, Esterni B, Malugani C, Charbonnier A, Coso D, de Colella JMS, Deconinck E, Caillot D, Viret F, Ladaique P, Lapierre V, Chabannon C. Occurrence and severity of adverse events after autologous hematopoietic progenitor cell infusion are related to the amount of granulocytes in the apheresis product. Transfusion 2007; 47:1268-75. [PMID: 17581163 DOI: 10.1111/j.1537-2995.2007.01267.x] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Adverse events (AEs) after hematopoietic progenitor cell (HPC) infusion are rare but might be life-threatening. These reactions have traditionally been associated with the amount of infused cryoprotectant, but persistence of such events after dimethyl sulfoxide (DMSO) depletion has questioned this assumption. STUDY DESIGN AND METHODS The incidence of AEs on a cohort of 460 patients (490 HPC infusions) undergoing autologous DMSO-reduced HPC transplantation was prospectively evaluated. HPCs were collected from adult patients with various hematologic or solid malignancies. After quality control (QC) on fresh apheresis products and subsequent cryopreservation, HPC grafts were thawed and washed at the cell therapy facility. QC was performed on each graft after washing, and clinical data were collected for each infusion. RESULTS AEs were reported in 66 cases (13.5%) and were graded according to the NCI-CTC scale from 1 to 4. Although none of the factors associated with patient characteristics or infusion procedure were different between the two groups (no AE vs. occurrence of AE), it was found that the absolute number of granulocytes measured before freezing was considerably higher in the AE group. Furthermore, within this group, there was a strong correlation between the amount of granulocytes and the grading of the reaction. CONCLUSION This survey demonstrates that AEs occurring in the setting of DMSO-reduced HPC grafts are directly related to the amount of granulocytes and thus emphasizes the need for high-quality apheresis products so as to improve the safety of HPC infusion.
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Affiliation(s)
- Boris Calmels
- Centre de Thérapie Cellulaire et Génique, Institut Paoli-Calmettes, Centre Régional de Lutte Contre le Cancer Provence-Alpes-Côte d'Azur, 13273 Marseille Cedex 9, France.
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Foïs E, Desmartin M, Benhamida S, Xavier F, Vanneaux V, Rea D, Fermand JP, Arnulf B, Mounier N, Ertault M, Lotz JP, Galicier L, Raffoux E, Benbunan M, Marolleau JP, Larghero J. Recovery, viability and clinical toxicity of thawed and washed haematopoietic progenitor cells: analysis of 952 autologous peripheral blood stem cell transplantations. Bone Marrow Transplant 2007; 40:831-5. [PMID: 17724443 DOI: 10.1038/sj.bmt.1705830] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Cryopreservation and thawing of haematopoietic stem cells are associated with cell loss and infusion-related toxicities. We analysed viability, total nucleated cell (TNC) and CD34+ cell recovery, and infusion-related toxicities of 952 thawed and washed products. Mean TNC and CD34+ viable cells recoveries were 55.9+/-18.6 and 98.0+/-36.5%, respectively. Mean cell viability was 68.25+/-18.9%. TNC recovery was correlated with viability but independent of the initial nucleated cell concentration. No difference in TNC recovery or viability was observed according to underlying diseases, except for myeloma, for which these variables were significantly lower (P<0.05). CD34+ cell recovery was not correlated with viability or CD34+ initial count and was similar for all diseases. Cryostorage duration was not associated with cell loss. Immediate adverse events occurred in 169 patients (19%) and were moderate (grade I or II) for the majority of patients. Clinical toxicity was associated with a higher infused cell number and the presence of clumps in infused bags. The washing procedure of cell products lead to a low rate of adverse events, but patients transplanted with high cell numbers or bags in which clumps were identified are predisposed to such complications.
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Affiliation(s)
- E Foïs
- Unité de Thérapie Cellulaire, Departement de Biotherapic, Assistance Publique-Hôpitaux de Paris, Hôpital Saint Louis, Paris, France
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Valeri CR, Ragno G. Cryopreservation of human blood products. Transfus Apher Sci 2006; 34:271-87. [PMID: 16872903 DOI: 10.1016/j.transci.2005.11.010] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2005] [Accepted: 11/23/2005] [Indexed: 11/30/2022]
Affiliation(s)
- C Robert Valeri
- Naval Blood Research Laboratory Inc., 195 Bournehurst Drive, Plymouth, MA 02360, USA.
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