Article ID | Journal | Published Year | Pages | File Type |
---|---|---|---|---|
8735171 | Transfusion Medicine Reviews | 2018 | 9 Pages |
Abstract
Adverse events (AEs) associated with blood transfusions, including component-specific red cell, platelet, and plasma products, have been extensively surveyed. In contrast, surveillance of AEs associated with hematopoietic stem cell (HSC) products in HSC transplantation (HSCT) has been less rigorous, even though HSC products include a diversity of immature and mature hematopoietic cells, substantial plasma, and dimethyl sulfoxide (DMSO) in the case of cryopreserved HSC products. HSC infusion-related AEs have been attributed to DMSO toxicity, but AEs associated with the infusion of noncryopreserved HSC products are not uncommon. To quantify the frequencies, types, and risk factors of HSC infusion-related AEs, we implemented national surveillance for AEs observed within 24â¯hours after infusion. Herein we report on 1125 HSCTs, including 570 peripheral blood stem cell transplantations (PBSCTs) (290 autologous [auto-] and 280 allogeneic [allo-]), 332 allo-bone marrow transplantations (allo-BMTs) and 223 allo-cord blood transplantations (allo-CBTs). Unexpectedly, incidences of gradeâ¯â¥â¯2 AEs were most frequent in allo-BMTs (37.7%) with no DMSO in any product compared with auto-/allo-PBSCTs (20.9%, Pâ¯<â¯.001) and allo-CBTs (19.3%, Pâ¯<â¯.001) typically cryopreserved with DMSO. Hypertension was most often noted in BMTs, whereas nausea/vomiting, fever, and allergic reactions were most frequent in allo-PBSCTs. In a multivariate analysis, a history of transfusion reactions was a risk factor for overall AEs in all HSCTs (odds ratio [OR]â¯=â¯1.459, P = .045). For gradeâ¯â¥â¯2 AEs in allo-HSCTs, a history of transfusion reactions (ORâ¯=â¯1.551, Pâ¯=â¯.044) for overall AEs, and high infusion volume (ORâ¯=â¯7.544, Pâ¯=â¯.005) and allo-PBSCTs (versus BMTs, ORâ¯=â¯9.948, Pâ¯= .002) for allergic reactions were identified as risk factors. These findings suggest that some factors unrelated to DMSO, such as allo-antigens, contribute to HSC infusion-related AEs. As severe AEs, a total of 117 gradeâ¯â¥â¯3 AEs were reported in 1125 HSCTs, including life-threatening complications in 3 (0.3%) HSCTs: 1 allo-CBT (anaphylaxis) and 2 allo-PBSCTs (hypoxia, kidney injury) with cryopreserved product. Our data show that HSC infusion risks vary by product, can be severe, and should be monitored with the same rigor as modern transfusion hemovigilance programs.
Related Topics
Health Sciences
Medicine and Dentistry
Hematology
Authors
Kazuhiko Ikeda, Hitoshi Ohto, Yoshiki Okuyama, Minami Yamada-Fujiwara, Heiwa Kanamori, Shin-ichiro Fujiwara, Kazuo Muroi, Takehiko Mori, Kinuyo Kasama, Tohru Iseki, Tokiko Nagamura-Inoue, Nobuharu Fujii, Takashi Ashida, Kazuaki Kameda, Junya Kanda,