Evaluation of acute toxicities associated with autologous peripheral bloodprogenitor cell reinfusion in patients undergoing high-dose chemotherapy

Peripheral blood progenitor cell reinfusion (PBPC) in patients undergoing h igh-dose chemotherapy (HDC) for poor prognosis malignancies, has been descr ibed as causing possible acute. gastrointestinal (nausea, vomiting), allerg ic (oedema, bronchospasm, anaphylaxis), renal (proteinuria, haematuria) and /or cardiovascular (hypotension, arrhythmia, conduction disturbances, trans ient ischaemic phenomena) toxicities. To establish the clinical relevance o f these observations and the possible relationship with different HDC regim ens used, we performed a clinical and instrumental evaluation on 33 patient s with advanced breast cancer, non-Hodgkin's lymphoma, Hodgkin's disease, r elapsed ovarian cancer, Ewing's sarcoma, extragonadal germinal tumour and s mall cell lung cancer. They underwent at least one reinfusion each for a to tal of 51 studied procedures. No patient had a previous history of cardiova scular disease or significant intercurrent illness such as diabetes or live r, renal or neurologic impairment. All patients had totally implanted centr al venous catheters, through which the transplants had been collected and r einfused without technical consequences. To evaluate cardiovascular functio n, we continuously monitored 12-lead ECGs, with arterial pressure (AP) meas urements every 5 min from the beginning of the procedure to 15 min after th e reinfusion ended. We did not observe any significant differences between basal and subsequent steps in AP, heart rate, PQ and QTc time, P wave and Q RS complex duration or P wave and QRS electrical axes. No patient showed an y ST-T tract pathological abnormality, but one patient developed a transien t ectopic atrial rhythm, without any haemodynamic disfunction and with spon taneous reversion to sinus rhythm. No patient complained of symptoms of hae modynamic failure. Gastrointestinal side-effects appeared to be strictly re lated to speed of reinfusion and to the number of packs reinfused, probably reflecting on the amount of dimethylsulphoxide infused. In one patient a t onic-clonic seizure occurred during a vomiting episode, but no patient deve loped allergic or renal toxicities, We conclude that PBPC reinfusion, if ma naged according to the procedure we propose in patients without organic imp airment, is a safe procedure not associated either with increased risk of a cute arrhythmias or ischaemic or significant systemic acute toxicities.