title: Adverse events of cryopreserved hematopoietic stem cell infusions in adults: a single-center observational study.
abstract: 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.
  
  
  
  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.
  
  
  
  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.
  
  
  
  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.
authors.affiliation: Department of Pathology and Immunology, Barnes-Jewish Hospital, Washington University, St Louis, Missouri.
authors.forename: Zaher K
authors.initials: ZK
authors.lastname: Otrock
authors.affiliation: Department of Pathology and Immunology, Barnes-Jewish Hospital, Washington University, St Louis, Missouri.
authors.forename: Diane S
authors.initials: DS
authors.lastname: Sempek
authors.affiliation: Department of Pathology and Immunology, Barnes-Jewish Hospital, Washington University, St Louis, Missouri.
authors.forename: Sherry
authors.initials: S
authors.lastname: Carey
authors.affiliation: Department of Pathology and Immunology, Barnes-Jewish Hospital, Washington University, St Louis, Missouri.
authors.forename: Brenda J
authors.initials: BJ
authors.lastname: Grossman
mesh_terms: D000328:Adult; D000368:Aged; D015925:Cryopreservation / Q000379:methods*; D003451:Cryoprotective Agents / Q000009:adverse effects*; D004121:Dimethyl Sulfoxide / Q000009:adverse effects; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006412:Hematopoietic Stem Cells / Q000187:drug effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D014182:Transplantation, Autologous / Q000009:adverse effects*; D055815:Young Adult
chemical_list: D003451:Cryoprotective Agents; D004121:Dimethyl Sulfoxide