Anaphylaxis during autologous peripheral blood progenitor cell infusion

Abstract

Summary:instances of systemic reactions resembling anaphylaxis have been reported in association with PBPC reinfusion; these reactions are frequently attributed to the presence of Anaphylaxis has been reported in subjects receiving peripheral blood precursor cell (PBPC) infusions; howdimethyl sulfoxide (DMSO) (in the cryopreserved cell preparations. [3][4][5] However, in vivo experience with DMSO ever the etiologic agent is unclear. Basophils from a PBPC-allergic subject were challenged with each indihas shown no association with anaphylactic reactions, and in vitro studies suggest that DMSO may actually inhibit vidual component of the stem cell infusion and with recombinant human (rh)DNAse. Histamine release data mediator release from both mast cells and basophils. 6,7 Thus, the pathogenesis of systemic reactions associated were compared with those using basophils from control subjects. Histamine release assays were repeated using with PBPC infusions remains unclear.We report herein the case of a subject with documented basophils from a control subject passively sensitized with serum IgE from the patient. Skin testing with bovanaphylaxis during two consecutive PBPC reinfusions. In vitro testing revealed IgE-mediated sensitivity to bovine ine DNAse was performed using standard techniques. Basophil histamine release occurred in the patient, but DNAse (commonly used to inhibit cellular aggregation), without crossreactivity to commercially available not in controls, with bovine DNAse. No release could be provoked by any of the other components of the infusrhDNAse, and no IgE-related sensitivity to DMSO. ate; no release could be detected with rhDNAse. Sensitivity to bovine DNAse could be transferred to basophils from a control subject with the serum IgE from the Case presentation patient. Marked epicutaneous skin test reactivity to bovine DNAse was evident in the patient, but not in control A 50-year-old female presented in November 1995 with primary peritoneal carcinoma and a CA-125 of 1037 IU/ml. subjects. We conclude that systemic reactions during peripheral blood precursor cell infusions may representIn December 1995, the patient began a regimen for mobilization of peripheral blood stem cells. Subsequent administrue IgE-mediated anaphylaxis to bovine DNAse in the infusate. Skin testing can detect such sensitivity, and the tration of high-dose carboplatin and paclitaxel in February 1996 was complicated by a hypersensitivity response to use of rhDNAse may obviate such reactions. Keywords: anaphylaxis; stem cell; IgE; DNAse; basopaclitaxel which was managed successfully utilizing newly published guidelines. 8 The patient's first stem cell reinphils fusion occurred 3 days later. Within 5 min of starting, the patient developed flushing with severe pruritus, gastrointestinal distress, shortness of breath, bronchospasm, tachyThe use of autologous peripheral blood progenitor cells cardia, profound hypotension, and altered sensorium. The (PBPCs) for bone marrow reconstitution in the treatment patient required intubatio...

Retroviral Vector-Modified Bone Marrow Stromal Cells Secrete Biologically Active Factor IXIn Vitroand Transiently Deliver Therapeutic Levels of Human Factor IX to the Plasma of Dogs after Reinfusion

“…Such a precaution is utilized in human clinical protocols for autologous bone martow transplantation (for examples, see Brenner et al, 1994;Deisseroth et al, 1994Deisseroth et al, , 1996Schuening et al, 1994). Transfusion-related allergic or anaphylactic reactions have been reported in response to xenogeneic (bovine) proteins present in transplanted cell preparations exposed to bovine semm-supplemented tissue culture medium before transplantation (Macy et al, 1989;Essayan et al, 1997).…”

Allogeneic Human Mesenchymal Stem Cells in Patients With Idiopathic Pulmonary Fibrosis

“…Importantly, current good manufacturing practice cell production techniques minimize unknown constituents, and washing greatly reduces dimethyl sulfoxide (DMSO) concentrations. [2][3][4] In the AETHER trial, subjects were screened for DMSO sensitivity, as the MSCs are exposed to DMSO during their production. We did not note any adverse events related to this reagent.…”

“…In future studies, if a second infusion is planned, this also needs to be given in an intensive care setting in view of the probable risk of anaphylaxis, which could develop due to foreign proteins/peptides in the infusate or the dimethyl sulfoxide that is commonly used as a preservative. 3 Patients may acquire sensitization to the reagent during the first infusion and subsequently react to the second infusion. In the AETHER study, it is not clear which agent was used as a cryopreservative.…”

Design, synthesis, and pharmacological characterization of some 2‐substituted‐3‐phenyl‐quinazolin‐4(3H)‐one derivatives as phosphodiesterase inhibitors

“…[ 4–6 ] To date, most of research on PDE inhibitors was centered on the PDE4 family owing to their promising results in neuroprotection. [ 7–9 ] However, their limited clinical use due to significant side effects such as emesis and sedation [ 10 ] directed attention to customized selective PDE4D inhibitors that have promising activity to restore memory impairment without inducing emesis. [ 11 ] Furthermore, searching for another cAMP‐specific PDE family such as PDE7 has been started to show up where several PDE7A inhibitors have been reported in the literature.…”