Acute life‐threatening cardiovascular toxicity with umbilical cord blood infusion: The role of dextran

Abstract

The main cause of hepatosplenomegaly in primary (PMF), post polycythemia vera (post-PV MF), and post essential thrombocythemia (post-ET MF) myelofibrosis (MF) is extramedullary hematopoiesis (EMH). Drug-refractory symptomatic splenomegaly in MF is usually managed by splenectomy or involved-field radiotherapy. The latter is most effective in the treatment of MF-associated bone pain and pulmonary hypertension. Our previous experience with hepatosplenic radiotherapy in MF showed efficacy in the majority of treated patients but its utility was limited by the transient nature of its benefit and the occurrence of treatment-related pancytopenia. In an effort to address these issues, we have adopted an induction-maintenance treatment strategy that utilizes lower radiation doses-induction with 100 cGy total in four daily doses of 25 cGy and maintenance with either the same or lower intensity regimen. Herein, we report our most recent experience using this treatment plan in two cases, who in addition to their expected response from the standpoint of splenomegaly, also unexpectedly showed a marked response of their underlying accelerated phase disease, including clearance of circulating blasts and basophilia.Case #1

Unexpected acute renal injury after high‐dose etoposide phosphate and total body irradiation in children undergoing hematopoietic stem cell transplantation

“…This component is known to induce RFI, via an accumulation of proximal tubular lysosomes, called “osmotic nephrosis,” when administered in high doses (from 50 to 1,000 g) – . Suspicions of a nephrotoxic effect for dextran 40 in the context of ASCT have been published . The patterns of kidney failure (within 24 hr after etoposide phosphate infusion) and recovery (within a few days) in our patients were very similar to those observed in patients presenting osmotic nephrosis …”

Umbilical Cord Blood Transplantation Is a Feasible Rescue Therapeutic Option for Patients Suffering from Graft Failure after Previous Hematopoietic Stem Cell Transplantation

“…Similar findings have been observed in the past [15] and have been attributed to the agents used for processing and cryopreservation of the UCB units (i.e. dimethylsulfoxide and dextran-40) [16]. …”

Low rate of infusional toxicity after expanded cord blood transplantation

“…18,19 Rarely, patients may suffer severe complications such as cardiac ischemia, pulmonary edema, and acute renal failure. 20,21 These AEs have been speculated to be the result of acute volume expansion, conditioning regimens, transfusion-related acute lung injury, and cell lysis products. 19,20 Furthermore, serious AEs have been attributed to components of the cryopreservation solution such as DMSO and Dextran-40.…”

“…19,20 Furthermore, serious AEs have been attributed to components of the cryopreservation solution such as DMSO and Dextran-40. 21–24 …”