|
Facebook
Twitter
Linkedin
|
 |
 |
 |
 |
Stem cell preservation in DMSO linked to stroke, MI after transplant
Monday, 29 November 1999 19:00 | 
| Radiology News - Radiology Articles |
Two patients given autologous stem cells cryopreserved in 10 per cent dimethyl sulfoxide (DMSO), developed encephalopathy, stroke and myocardial infarction after stem cell transplantation.
Two patients given autologous stem cells cryopreserved in 10 per cent dimethyl sulfoxide (DMSO), developed encephalopathy, stroke and myocardial infarction after stem cell transplantation. Boston investigators believe the neurologic and myocardial complications may be due to DMSO.
The two cases are described by Dr. Alice S. Chen-Plotkin of Brigham and Women's Hospital and colleagues in the March issue of Neurology.
Autologous stem cell transplants were given for consolidation of stage IV mantle cell lymphoma in one case and for refractory multiple myeloma with renal insufficiency in the other.
Both patients became unresponsive and showed signs of acute neurologic impairment immediately after stem cell transfusion. Acute symptoms lasted for less than an hour in one case and for a matter of hours in the other.
Magnetic resonance imaging (MRI) revealed multiple acute strokes, "but the degree of encephalopathy was out of proportion to the burden of cerebral infarction seen on imaging," the investigators write.
Cardiac enzymes rose within hours of stem cell transplantation and ejection fractions dropped in both cases. Non-ST-elevation myocardial infarction was diagnosed in both cases. In one case, myocardial infarction resulted in a permanent impairment in ejection fraction.
Dr. Chen-Plotkin and colleagues suggest it is possible that the cerebral and myocardial infarctions were linked "through sympathovagal dysregulation."
Encephalopathy has been described before with infusions of DMSO in humans. In an animal model, DMSO has been shown to cause acute vasospasm, and this or another mechanism "may explain our patients' symptoms," the Boston team continues.
"Although 10 per cent DMSO is a standard carrier for stem cells, alternative agents or a lesser concentration of DMSO may be safer and equally effective. Although a cryopreservative is obligatory for autologous stem cell transplants, allogeneic transplants may avoid this toxic exposure entirely by using freshly harvested cells whenever possible," the investigators note.
"These are preliminary observations in two patient cases," Dr. Chen-Plotkin tells Reuters Health. "However, stem cell transplantations are being done more and more, for a number of different diseases. Further systematic investigation into rates of complications with DMSO of different concentrations or with other carrier agents would be beneficial in making sure patients can get these stem cell transplants as safely as possible."
Neurology 2007;68:859-861.
The two cases are described by Dr. Alice S. Chen-Plotkin of Brigham and Women's Hospital and colleagues in the March issue of Neurology.
Autologous stem cell transplants were given for consolidation of stage IV mantle cell lymphoma in one case and for refractory multiple myeloma with renal insufficiency in the other.
Both patients became unresponsive and showed signs of acute neurologic impairment immediately after stem cell transfusion. Acute symptoms lasted for less than an hour in one case and for a matter of hours in the other.
Magnetic resonance imaging (MRI) revealed multiple acute strokes, "but the degree of encephalopathy was out of proportion to the burden of cerebral infarction seen on imaging," the investigators write.
Cardiac enzymes rose within hours of stem cell transplantation and ejection fractions dropped in both cases. Non-ST-elevation myocardial infarction was diagnosed in both cases. In one case, myocardial infarction resulted in a permanent impairment in ejection fraction.
Dr. Chen-Plotkin and colleagues suggest it is possible that the cerebral and myocardial infarctions were linked "through sympathovagal dysregulation."
Encephalopathy has been described before with infusions of DMSO in humans. In an animal model, DMSO has been shown to cause acute vasospasm, and this or another mechanism "may explain our patients' symptoms," the Boston team continues.
"Although 10 per cent DMSO is a standard carrier for stem cells, alternative agents or a lesser concentration of DMSO may be safer and equally effective. Although a cryopreservative is obligatory for autologous stem cell transplants, allogeneic transplants may avoid this toxic exposure entirely by using freshly harvested cells whenever possible," the investigators note.
"These are preliminary observations in two patient cases," Dr. Chen-Plotkin tells Reuters Health. "However, stem cell transplantations are being done more and more, for a number of different diseases. Further systematic investigation into rates of complications with DMSO of different concentrations or with other carrier agents would be beneficial in making sure patients can get these stem cell transplants as safely as possible."
Neurology 2007;68:859-861.
