Feasibility, efficacy, and safety of cell‐free and concentrated ascites reinfusion therapy (KM‐CART) for malignant ascites

Abstract

Efficacy for alleviating signs/symptoms of malignant ascites of a renovated CART (cell‐free and concentrated ascites reinfusion therapy) system, called KM‐CART, was evaluated. A total of 4781 KM‐CART procedures were performed in 2109 patients. All patients were accepted unless hemodynamically unstable or consciousness impaired. The ascites were processed and drip‐infused into the patient. There were no major complications or deaths. The mean drainage volume was 6.2 L (maximum: 27.7 L), patient symptoms (numerical scale system) were significantly alleviated (45.1 ± 19.0 reduced to 21.2 ± 14.2, P < .001), and patient leg circumference significantly decreased (33.3 ± 4.4 cm reduced to 30.5 ± 4.4 cm, P < .001) without exacerbation of renal function. Collected cancer cells could be utilized for immune therapy. KM‐CART is capable of improving the “quality of best supportive care” and can be beneficial in conjunction with medication for alleviating malignant pain.

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

“…One of the criticisms of our study was the low recovery rate of total protein and albumin in the processing of ascites (44.9 and 49.0%, respectively). In the modi ed CART (KM-CART) procedure, the recovery rates of albumin and globulin in 11 cancer patients were reported to be 71.1 ± 9.6% and 57.6 ± 7.1%, respectively, without membrane cleaning [14], while the protein recovery rate was 40.7 ± 14.0% in 4781 procedures with membrane cleaning [9], which were comparable to the data in this study. Frequent membrane cleaning therefore reduced the recovery rates of total protein and albumin.…”

“…We utilized a modi ed CART procedure, known as KM-CART, which employs an external pressure system using suction equipment and also utilizes lter membrane cleaning [9,14]. Brie y, abdominal paracentesis was performed using a 14-G, 30-cm central venous catheter inserted into the abdominal cavity under ultrasonographic monitoring.…”

“…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].…”

Malignant Ascites

“…The hypothesized mechanism of this therapy is to reinfuse autologous proteins including albumin back into circulation to try to decrease complications that occur with total paracentesis alone. 49 After paracentesis, the ascitic fluid is filtered to remove bacteria and malignant cells and then concentrated, before being infused into a peripheral vein. Many studies have demonstrated improvement in symptoms, increase in total serum protein level, increase in estimated glomerular filtration rate, and increase in urine volume after CART treatment.…”

“…Many studies have demonstrated improvement in symptoms, increase in total serum protein level, increase in estimated glomerular filtration rate, and increase in urine volume after CART treatment. 49 Adverse events included hypotension (5.3%) and fever (3.4%). The median time to next paracentesis was 27 days after CART compared with 10 to 14 days with paracentesis alone.…”