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

Kazuhiko Ikeda, Hitoshi Ohto, Minami Yamada-Fujiwara, Yoshiki Okuyama, Shin ichiro Fujiwara, Kazuo Muroi, Takehiko Mori, Kinuyo Kasama, Heiwa Kanamori, Tohru Iseki, Tokiko Nagamura-Inoue, Kazuaki Kameda, Junya Kanda, Kazuhiro Nagai, Nobuharu Fujii, Takashi Ashida, Asao Hirose, Tsutomu Takahashi, Keiji Minakawa, Ryuji Tanosaki

Research output: Contribution to journalArticle

Abstract

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. We aimed to clarify if product volume and component effects are more substantial in small recipients including children. STUDY DESIGN AND METHODS: We performed subgroup analysis on 219 recipients of 45 kg or less body weight (whole small recipients), including 90 children (pediatric recipients), from the original cohort (general recipients). RESULTS: Whereas overall HCI-AE rates did not differ among hematopoietic stem cell sources in the general recipients, bradycardia most often occurred after CBT in whole small recipients. Conversely, whole small and general recipients shared the same trend of having the highest rate of hypertension in BMT. The overall HCI-AE rate was higher in allogeneic HSCT compared with autologous HSCT. Notably, pediatric recipients showed a 10-fold higher incidence of nausea and vomiting in allogeneic HSCT compared with autologous HSCT, suggesting a possible role of allogeneic antigens. Multivariate analysis identified a relatively large infusion volume per body weight as a significant factor correlating with HCI-AE in whole small recipients. CONCLUSIONS: We should be aware of product volume and specific HCI-AEs such as nausea and vomiting in small patients including children.

Original languageEnglish
Pages (from-to)1015-1023
Number of pages9
JournalTransfusion
Volume60
Issue number5
DOIs
Publication statusPublished - 2020 May 1

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology
  • Hematology

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    Ikeda, K., Ohto, H., Yamada-Fujiwara, M., Okuyama, Y., Fujiwara, S. I., Muroi, K., Mori, T., Kasama, K., Kanamori, H., Iseki, T., Nagamura-Inoue, T., Kameda, K., Kanda, J., Nagai, K., Fujii, N., Ashida, T., Hirose, A., Takahashi, T., Minakawa, K., & Tanosaki, R. (2020). Hematopoietic cell infusion-related adverse events in pediatric/small recipients in a prospective/multicenter study. Transfusion, 60(5), 1015-1023. https://doi.org/10.1111/trf.15786