Efficacy and safety of reinfusion of concentrated ascitic fluid for malignant ascites: a concept-proof study

Hanada, R; Yokomichi, Naosuke; Kato, Chiho; Miki, Kazumi; Oyama, Sachiko; Morita, Tatsuya; Kawahara, Ryuichi

doi:10.1007/s00520-017-3980-5

Cited by 11 publications

(12 citation statements)

References 29 publications

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“…In the overall CART procedure, the most common AEs were fever and fever-related symptoms, such as chills after the reinfusion of concentrated ascites. The frequency of fever in this study, 5.6% (13 events), was comparable to that in previous studies, 5-16.4% [8,11,16,17]. The average increase in body temperature was reported to be 0.1-0.…”

Section: Discussionsupporting

confidence: 87%

“…Fever is a transient and mild AE in CART; however, its management is still important and valuable because CART is usually performed as a palliative therapy [1,11]. Especially in cancer patients, the characteristics and contents of reinfused concentrated ascites vary according to those of the original ascites and modi cation through the CART procedure.…”

Section: Discussionmentioning

confidence: 99%

“…CART itself is expected to improve ascites-associated symptoms (e.g., abdominal distension, general fatigue, dyspnea and loss of appetite) as a palliative therapy, as well as renal dysfunction, while retaining the use of albumin preparation [1,[6][7][8][9]. CART combined with chemotherapy has been reported to be associated with a survival advantage in comparison to chemotherapy alone [10][11][12]. CART was reported to improve sinusoidal obstructive syndrome after hematopoietic stem cell transplantation [13].…”

Section: Introductionmentioning

confidence: 99%

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Adverse Effects of Cell Free and Concentrated Ascites Reinfusion Therapy (CART) for Malignant Ascites: A Single Institute Experience

Tsubokura¹,

Adegawa²,

Kojima³

et al. 2020

Preprint

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Background: Cell-free and concentrated ascites reinfusion therapy (CART) is a strategy to improve hypoalbuminemia due to refractory ascites. CART has recently been applied in the treatment of cancer patients. This study was performed to assess the safety of CART in a single cancer institute.Methods: We retrospectively reviewed 233 CART procedures that were performed for 132 cancer patients in our institute. Results: The median volume of ascites before and after concentration was 4,720 and 490 mL (median concentration rate, 10.0-fold), The median amounts of total protein and albumin were 64.0g and 32.6g (median recovery rates, 44.9% and 49.0%), respectively. Thirty-three adverse events (AEs) were observed in 22 (9.4%) of 233 procedures; 30 of these events occurred after reinfusion. The most common reinfusion-related AEs were fever (13 events) and chills (10 events). Univariate analyses revealed no significant relationships between the frequency of AEs and age, sex, appearance of ascites, volume of harvested and concentrated ascites, the ascites processing rate (filtration and concentration), volume of saline used for membrane cleaning, amount of calculated total protein for infusion, or prophylaxis against AEs; the reinfusion rate >100 mL/h affected the frequency of AEs, regardless of the prophylactic use of steroids. Conclusions: The observed AEs were mainly mild cytokine-related reactions after reinfusion, which were related to a reinfusion rate of >100 mL per hour. Although our study was retrospective in nature and undertaken in a single institute, this information may be helpful for the management of cancer patients with refractory malignant ascites using CART.

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Section: Discussionsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Adverse Effects of Cell Free and Concentrated Ascites Reinfusion Therapy (CART) for Malignant Ascites: A Single Institute Experience

Tsubokura¹,

Adegawa²,

Kojima³

et al. 2020

Preprint

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“…As almost all studies on CART are case series with no set controls, evaluating the clinical merits of CART is difficult 31 . Even controlled comparisons with simple paracentesis, which is the most common non-drug treatment for ascites 17,18 , have not been conducted 32 . The objective of the current investigation was to verify the serum albumin elevating effect of CART by controlled study with simple paracentesis.…”

Section: Introductionmentioning

confidence: 99%

Verification of serum albumin elevating effect of cell-free and concentrated ascites reinfusion therapy for ascites patients: a retrospective controlled cohort study

Yamada

Inui

Hara

et al. 2019

Sci Rep

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Cell-free and concentrated ascites reinfusion therapy (CART) is frequently used to treat refractory ascites in Japan. However, its efficacy remains unclear. This controlled cohort study verified the serum albumin elevating effect of CART by comparisons with simple paracentesis. Ascites patients receiving CART (N = 88) or paracentesis (N = 108) at our hospital were assessed for the primary outcome of change in serum albumin level within 3 days before and after treatment. A significantly larger volume of ascites was drained in the CART group. The change in serum albumin level was +0.08 ± 0.25 g/dL in the CART group and −0.10 ± 0.30 g/dL in the paracentesis group (P < 0.001). The CART – paracentesis difference was +0.26 g/dL (95%CI +0.18 to +0.33, P < 0.001) after adjusting for potential confounders by multivariate analysis. The adjusted difference increased with drainage volume. In the CART group, serum total protein, dietary intake, and urine volume were significantly increased, while hemoglobin and body weight was significantly decreased, versus paracentesis. More frequent adverse events, particularly fever, were recorded for CART, although the period until re-drainage was significantly longer. This study is the first demonstrating that CART can significantly increase serum albumin level as compared with simple paracentesis. CART represents a useful strategy to manage patients requiring ascites drainage.

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“…There have been only a limited number of studies on the palliative management of patients with malignant-related ascites; many of them chose overall survival, puncture-free survival, time to the next paracentesis, signs and symptoms related to ascites, and common terminology criteria for adverse events as outcomes, but few assessed patient-reported outcomes with validated tools. 2,5,6,23,24 Given the weak evidence supporting the efficacy of treatment modalities for symptomatic malignant-related ascites, clinical trials with the utilization of validated patient-reported outcomes are urgently needed. 1,3 The validation of the ESAS:AM may facilitate such initiatives in the future.…”

Section: Discussionmentioning

confidence: 99%

Validation of the Edmonton Symptom Assessment System: Ascites Modification

Mori

Morita

Yokomichi

et al. 2018

Journal of Pain and Symptom Management

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Efficacy and safety of reinfusion of concentrated ascitic fluid for malignant ascites: a concept-proof study

Cited by 11 publications

References 29 publications

Adverse Effects of Cell Free and Concentrated Ascites Reinfusion Therapy (CART) for Malignant Ascites: A Single Institute Experience

Adverse Effects of Cell Free and Concentrated Ascites Reinfusion Therapy (CART) for Malignant Ascites: A Single Institute Experience

Verification of serum albumin elevating effect of cell-free and concentrated ascites reinfusion therapy for ascites patients: a retrospective controlled cohort study

Validation of the Edmonton Symptom Assessment System: Ascites Modification

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