Transient global amnesia associated with the infusion of DMSO-cryopreserved autologous peripheral blood stem cells

Abstract

Dimethylsulfoxide (DMSO) is a solvent commonly used for the cryopreservation of autologous peripheral blood stem cells (APBSC). Side effects upon infusion of DMSO-cryopreserved APBSC mainly consist of nausea, emesis, chills, rigors, and cardiovascular events, such as bradyarrhythmia or hypotension. We report the case of a patient who received DMSO-cryopreserved APBSC after myeloablative chemotherapy for a relapsing lymphoma. The patient developed a rare reaction during the infusion manifesting as transient global amnesia. The clinical course during the reaction is described and an explanation of the possible causes is discussed. This observation underlines the need for an adequate DMSO depletion to limit neurotoxicity or other adverse manifestations.

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

“…The earliest reports of DMSO toxicity during stem cell infusion describe characteristic side effects such as nausea, vomiting, abdominal pain, chills and fever. 1,2 Rare but serious side effects of cryopreserved products include severe respiratory depression, 7 neurotoxicity resulting in amnesia, loss of consciousness or seizure 5,6 and fatal cardiac arrhythmia. 4 Efforts aimed at reducing the DMSO content of infused grafts either by washing or other means have resulted in a reduction of ARs among some studies, 8,9 but not others.…”

“…These range from common mild reactions including nausea, vomiting, flushing, fever, chills and cough [1][2][3] to rare life-threatening reactions affecting the cardiovascular, respiratory and neurological systems. [4][5][6][7] Infusion-related ARs have been attributed to both cellular and non-cellular elements within the cellular therapy product (CTP). In addition to the desired CD34 + hematopoietic stem cells, CTPs contain a wide variety RBC, cytokines and WBC including mature granulocytes, lymphocytes and monocytes, all of which may contribute to infusion-related reactions.…”

DMSO-associated encephalopathy during autologous peripheral stem cell infusion: a predisposing role of preconditioning exposure to CNS-penetrating agents?

“…Animal model data and clinical observations indicated that this agent may affect the vascular system leading to prolonged vasoconstriction and cerebrovascular ischaemia, [1][2][3][4][5]8 even though neuroimaging did not display a 'vascular' pattern in all of the cases (Table 1). Idiosyncratic mechanisms, a predisposing genetic background and a direct effect of DMSO on neural cell metabolism have also been hypothesized.…”

“…Idiosyncratic mechanisms, a predisposing genetic background and a direct effect of DMSO on neural cell metabolism have also been hypothesized. [5][6][7]9 Whether the occurrence of neurotoxicity is related to the amount of DMSO infused (maximal recommended dose is 1000 mg/kg or 10 ml/kg of a 10% solution) and/or to infusion rate also remains controversial. 7 Our patient developed symptoms after receiving only 10.5 ml of DMSO at a low infusion rate, suggesting that patient-related factors might have also contributed to the development of neurotoxicity.…”

“…DMSO-related neurotoxicity, including transient global amnaesia, cerebral infarction, migraine, seizures, encephalopathy and coma, has been described, mostly as anecdotal events. [1][2][3][4][5][6] The heterogeneity of neurologic syndromes and the pleiotropic actions of DMSO have hampered the formulation of univocal pathogenetic hypotheses and the understanding of their putative clinical correlates. Efforts to identify predisposing factors for DMSO-related neurotoxicity have been unsuccessful, and even the presence of preexisting cerebral disease does not predict for such risk.…”