Limiting the Daily Total Nucleated Cell Dose ofCryopreserved Peripheral Blood Stem Cell Productsfor Autologous Transplantation Improves Infusion-Related Safety with No Adverse Impact onHematopoietic Engraftment

Nandita Khera, Jack Jinneman, Barry E. Storer, Shelly Heimfeld, Megan M. O'Meara, Thomas R. Chauncey, Stephanie J. Lee, Michael Linenberger

Research output: Contribution to journalArticle

4 Scopus citations

Abstract

Cryopreserved peripheral blood stem cell (PBSC) products can induce a number of infusion-related adverse reactions, including life-threatening cardiac, neurologic, and other end-organ complications. Preliminary analyses suggested limiting the daily total nucleated cell dose infused might decrease the incidence of these adverse effects. A policy change implemented in December 2007, limiting the total nucleated cell (TNC) dose to <1.63 × 109 TNC/kg/day, allowed us to assess the impact of this intervention on infusion-related safety, infusion schedules, engraftment, and costs in cohorts of patients undergoing autologous stem cell transplants (ASCTs) 2 years before (325 ASCTs in 288 patients) and 2 years after the policy change (519ASCTs in 479 patients). The percentage of autologous transplant patients requiring multiple day infusions increased from 6% to 24%. Concurrently, the incidence of infusion-related grade 3-5 severe infusion-related adverse events (SAEs) decreased significantly, from 4% (13 of 325) prepolicy change to 0.6% (3 of 519) postpolicy change (P < .0004). Multiday infusions were not associated with increased time to neutrophil or platelet engraftment or the costs of transplantation. We conclude that limiting the daily TNC dose improved the safety of this procedure without compromising engraftment or increasing the costs of the procedure.

Original languageEnglish (US)
Pages (from-to)220-228
Number of pages9
JournalBiology of Blood and Marrow Transplantation
Volume18
Issue number2
DOIs
StatePublished - Feb 2012

Keywords

  • Autologous stem cell infusions
  • Cryopreserved peripheral blood stem cells
  • Infusion-related adverse events
  • Total nucleated cell dose

ASJC Scopus subject areas

  • Hematology
  • Transplantation

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