Neurotoxicity Associated With Dimethyl Sulfoxide Used in Allogeneic Stem Cell Transplantation

Abstract

Dimethyl sulfoxide (DMSO) is a cryoprotective agent used in storage of frozen stem cells in stem cell transplantation. Central nervous system side effects of DMSO such as epileptic seizures, stroke, transient global amnesia, and temporary leucoencephalopathy are rarely seen. Here, we report a pediatric patient who developed seizures after DMSO-cryopreserved stem cell infusion and whose magnetic resonance imaging of the brain demonstrated parietal and occipital focal cortical T2-signal intensity increase. DMSO toxicity should be kept in mind in patients who received cryopreserved stem cell infusion and magnetic resonance imaging may be helpful in differential diagnosis of central nervous system involvement.

Aislamiento de células madre mesenquimales derivadas de tejido adiposo del pliegue inguinal murino: un protocolo para obtener lo mejor de pequeñas muestras

“…That confirms the toxicity of this cryoprotective agent to ASCs, being a toxic substance at room temperature that damages cells when used at high concentrations or inadequately. Other researchers have reported that cryopreservating cells using DMSO at 10 % concentration within the medium has caused adverse effects in patients that receive stem cells as therapy, such as: respiratory reactions and neurotoxicity in pediatric patients, which clearly indicates the need to reduce its use or look for other cryoprotective agents when aiming to scale up to clinical therapies [37] [38].…”

Reações adversas no dia zero do transplante de células-tronco hematopoéticas: revisão integrativa

“…Of the 18 studies that composed the sample, two were of the case report type and 16 used other methodologies. The frequency of adverse reactions varied from 0% with the infusion of fresh bone marrow (33) to 80% with the infusion of umbilical cord blood and cryopreserved placental blood (22) . A study developed in Canada with pediatric patients receiving fresh BM showed a 45% frequency of AR that are related to the final volume of the product and the presence of incompatibility of the ABO system between donor and recipient (2,14) .…”

“…In 13 studies, the source of the HSC was peripheral blood (5,12,(18)(19)21,(23)(24)(25)(26)(27)(28)(29)32) . A Turkish study used only bone marrow (33 ) and another Japanese study only the umbilical cord and the placental blood (22) . Only in the Italian and Canadian studies more than one source were used: BMandPB (20) and the three sources (31) .…”

“…In addition to the DMSO, other variables such as granulocyte count, sex and diagnosis are risk factors for the occurrence of AR. E 18 (33) AR: In the infusion of fresh HSC: no AR. Cryopreserved HSC infusion: headache, hypertension, bradycardia, hypothermia and convulsion.…”

“…Studies carried out in Turkey (33) , United States (29) and Canada (31) showed differences regarding the infusion modalities (fresh and cryopreserved). In the case report developed in Turkey, the patient received infusion of fresh bone marrow on the first day and cryopreserved BM on the second day.…”