title: Severe motor aphasia after reinfusion of cryopreserved autologous stem cells after myeloablative conditioning.
abstract: BACKGROUND
  Autologous peripheral blood stem cells (PBSCs) are usually cryopreserved before high-dose chemotherapy (HDCT) and autologous peripheral blood stem cell transplantation (PBSCT). The freezing process requires the addition of cryoprotectants such as dimethyl sulfoxide (DMSO), which is vital for cell viability in frozen aliquots. DMSO has a number of well-described side effects. However, severe neurologic side effects assigned to DMSO are exceedingly rare.
  
  
  METHODS
  A 64-year-old female underwent HDCT followed by PBSCT as consolidation therapy in relapsed high-grade (Grade 3B) Stage IIIA follicular lymphoma. PBSCs were mobilized using granulocyte-colony stimulating factor and plerixafor after the second cycle of R-DHAP (rituximab, dexamethasone, high-dose Ara-C, cisplatin) salvage chemotherapy. A total of 7.18 × 106/kg body weight CD34+ cells were cryopreserved using 10% DMSO. HDCT was administered some weeks later followed by reinfusion of two bags of PBSCs, each containing 98 mL with 1.6 × 106/kg body weight CD34+ cells. Within a few minutes the patient developed a motor aphasia and became very agitated. Brain imaging did not reveal any pathologic finding. After being transferred to the intensive care unit the patient's condition steadily improved and the motor aphasia resolved completely within 6 hours after its onset.
  
  
  CONCLUSIONS
  This is, to our knowledge, the first report to describe an episode of severe motor aphasia during PBSCT. Given the close timely correlation with PBSCT, this episode appears to be caused by dimethyl sulfoxide (DMSO) and might possibly have been prevented by use of lower concentrations of DMSO.
authors.affiliation: Klinikum Schwabing, Clinic of Hematology, Oncology, Immunology, Palliative Medicine, Infectious Diseases and Tropical Medicine, Munich.
authors.forename: Andreas
authors.initials: A
authors.lastname: Hausmann
authors.affiliation: Klinikum Schwabing, Clinic of Hematology, Oncology, Immunology, Palliative Medicine, Infectious Diseases and Tropical Medicine, Munich.
authors.forename: Norbert
authors.initials: N
authors.lastname: Fischer
authors.affiliation: Klinikum Schwabing, Clinic of Hematology, Oncology, Immunology, Palliative Medicine, Infectious Diseases and Tropical Medicine, Munich.
authors.forename: Stephan
authors.initials: S
authors.lastname: Breitkopf
authors.affiliation: Klinikum Schwabing, Clinic of Hematology, Oncology, Immunology, Palliative Medicine, Infectious Diseases and Tropical Medicine, Munich.
authors.forename: Franziska
authors.initials: F
authors.lastname: Menne
authors.affiliation: Klinikum Schwabing, Clinic of Hematology, Oncology, Immunology, Palliative Medicine, Infectious Diseases and Tropical Medicine, Munich.
authors.forename: Kerstin
authors.initials: K
authors.lastname: Jess
authors.affiliation: Klinikum Schwabing, Clinic of Cardiology, Pneumology and Intensive Care, Munich, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Schmidmayr
authors.affiliation: Klinikum Schwabing, Clinic of Hematology, Oncology, Immunology, Palliative Medicine, Infectious Diseases and Tropical Medicine, Munich.
authors.forename: Clemens M
authors.initials: CM
authors.lastname: Wendtner
authors.affiliation: Redcross Hospital Munich, Department of Medicine III, Academic Teaching Hospital of the University of Munich. marcus.hentrich@swmbrk.de.
authors.forename: Marcus
authors.initials: M
authors.lastname: Hentrich
mesh_terms: D001039:Aphasia, Broca / Q000139:chemically induced*; D015925:Cryopreservation / Q000379:methods*; D004121:Dimethyl Sulfoxide / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008224:Lymphoma, Follicular / Q000628:therapy; D008875:Middle Aged; D019653:Myeloablative Agonists / Q000627:therapeutic use; D036102:Peripheral Blood Stem Cell Transplantation / Q000379:methods*; D019172:Transplantation Conditioning / Q000379:methods; D014182:Transplantation, Autologous
chemical_list: D019653:Myeloablative Agonists; D004121:Dimethyl Sulfoxide