Adverse reactions during stem cell infusion in children treated with autologous and allogeneic stem cell transplantation

Abstract

Adverse reactions (ARs) during the infusion of cellular therapy products (CTPs) are common in patients undergoing hematopoietic stem cell transplantation (HSCT). We retrospectively studied pediatric patients undergoing autologous and allogeneic HSCT to determine the incidence and grade of ARs during stem cell infusion and their predictors. We analyzed data from 213 patients (120 allogeneic and 93 autologous) who received at least 1 CTP, totaling 361 infusion episodes. Serious ARs, defined as grade 2 and 3, occurred in 25 and 11% of infusions, respectively. No grade 4 or 5 ARs were noted. Independent risk factors for developing a serious AR included stem cell source (PBSC vs marrow (odds ratio (OR) 1.8, 95% confidence interval (CI): 0.4-9); cord vs marrow (OR 7.3, 95% CI: 1.3-40), overall P = 0.0001) but manipulated CTPs were protective (OR 0.4, 95% CI: 0.2-0.7, P = 0.004). Unlike previous adult studies, WBC and granulocyte content were not found to be risk factors in this pediatric population. These data suggest that children tolerate higher WBC content during infusion of CTPs and support the use of manipulated CTP, as indicated, to reduce the risk of adverse infusion reactions.

Hematopoietic cell infusion‐related adverse events in pediatric/small recipients in a prospective/multicenter study

“…It is unclear if product volume and component effects are more substantial in recipients with a small body, and if recipients' age-related factors alter susceptibility to HCI-AEs in pediatric recipients. However, there have been few retrospective studies from single centers for HCI-AEs in pediatric recipients, 15,16 and data on HCI-AEs in small and pediatric recipients are lacking.…”

“…influenced by type of HSC sources or mobilization by granulocyte colony-stimulating factor. 20,21 Although the cytokines have been speculated as a factor of HCI-AEs, 16,22 their role needs to be elucidated in the future.…”

“…Kazuhiko Ikeda , 1,2 Hitoshi Ohto, 1,2 Minami Yamada-Fujiwara, 1,3 Yoshiki Okuyama, 1,4 Shin-ichiro Fujiwara , 1,5 Kazuo Muroi, 1,6 Takehiko Mori, 7 Kinuyo Kasama, 8 Heiwa Kanamori, 1,9 Tohru Iseki, 1,10 Tokiko Nagamura-Inoue, 1,11 Kazuaki Kameda, 12 Junya Kanda, 13 Kazuhiro Nagai, 14 Nobuharu Fujii, 15 Takashi Ashida, 16 Asao Hirose, 17 Tsutomu Takahashi, 18 Keiji Minakawa, 2 and Ryuji Tanosaki 1 BACKGROUND: Hematopoietic cell infusion-related adverse events (HCI-AEs) in hematopoietic stem cell transplantations (HSCTs) have been largely attributed to toxicity of dimethyl sulfoxide (DMSO) for cryopreservation, but HSC products also contain various cells and plasma components. Our recent prospective study of 1125 HSCT recipients revealed the highest overall HCI-AE rate in bone marrow transplantation (BMT) using fresh/noncryopreserved products, although products of peripheral blood stem cell transplantation and cord blood transplantation (CBT) are generally cryopreserved with DMSO containing smaller plasma volumes.…”

Management guidelines for paediatric patients receiving chimeric antigen receptor T cell therapy

“…Characteristic adverse reactions include nau sea, vomiting, abdominal pain, chills, fever, and, rarely, severe respiratory depression, neurotoxicity, and cardiac arrhythmias [86][87][88][89][90][91][92][93] . General management principles for infusion reactions associated with adoptive cell therapy include consideration of slowing or halting the infusion, activation of emergency precautions, and confirmation of product details for accuracy.…”

Principles of Conditioning Therapy and Cell Infusion

“…Fresh (Costa et al 2014;Tomlinson and Kline 2010;Truong et al 2016;Vidula et al 2015) 6.6.2 Nursing Care: Pre-, During and Post Stem Cell Infusion…”