Adverse events occurring during bone marrow or peripheral blood progenitor cell infusion: analysis of 126 cases.

Bone marrow (BM) and/or peripheral blood progenitor cells (PBPC) given after high-dose chemo-radiotherapy are commonly cryopreserved. Re-infusion of the thawed product can cause cardiovascular and other complications. We compared two groups of adult patients receiving autologous BM or PBPC transplant to assess the incidence of adverse events occurring during infusion. Fifty-one patients received BM, and 75 PBPC. The two groups were comparable in respect of age, total volume infused, quantity of dimethylsulfoxide (DMSO) and number of polymorphonuclear neutrophils. Patients receiving PBPC had a higher number of nucleated cells per kg of body weight; those in the BM group received a significantly greater quantity of red cells. Non-cardiovascular complications occurred in 19% and 8% of patients rescued by BM and PBPC respectively. The incidence of hypertension was 21% in the BM and 36% in the PBPC group. Asymptomatic hypotension was more frequent in PBPC patients (P<0.001). Bradyarrhythmia was noticed in two of 75 PBPC patients and in 14 of 51 BM patients (P<0.001). In the former group one patient had heart block; he died of renal failure 10 days later. Bradycardia and hemoglobinuria were more common in patients receiving BM where a higher concentration of red cells was present (P<0.001). Since bradyarrhythmias may be a life-threatening complication we advise continuous careful monitoring during infusion of thawed BM. The strong correlation between bradycardia and red blood cell contamination suggests the use of purified products with a very low red cell content.

Serine protease detection in mixed lymphocyte cultures: a histochemical method for possible prediction of graft-versus-host disease.

BACKGROUND AND OBJECTIVE: Graft-versus-host disease (GVHD) presents an important complication of allogeneic bone marrow transplantation. A method to predict GVHD might be the analysis of cytotoxic T lymphocyte precursors, but the technique requires the use of radioactive elements not suitable in all laboratories. DESIGN AND METHODS: Serine esterase (SE) activity was studied by a cytochemical method in donor-recipient mixed lymphocytes cultures (MLC). Twelve patients, affected by acute or chronic leukemia, and 20 donors were studied. MLC incubated with and without growth factors (IGF-1 or IL-2), were analyzed. The relationship between positivity of MLC and GVHD in transplanted patients was evaluated. RESULTS: The data obtained showed that the percentage of SE positive cells was higher in MLC compared to negative control MLC. The highest percentage of positive cells was found in the MLC obtained from unrelated subjects. INTERPRETATION AND CONCLUSIONS: These results show that serine protease expression in MLC may be a predictive marker of GVHD and could be used as an additional early test associated with cytotoxicity.