Texas Transplant Institute, 7711 Louis Pasteur, San Antonio, TX, USA.
Biol Blood Marrow Transplant. 2012 Jul;18(7):1055-60. doi: 10.1016/j.bbmt.2011.12.500. Epub 2011 Dec 16.
Seizures as a complication of the infusion of autologous peripheral blood stem cells (PBSC) are rare. Seizures during infusion of autologous PBSC in 3 of our patients prompted us to review our cell therapy and cytapheresis protocols and procedures. We retrospectively analyzed 159 adult patients collected between January 2006 and July 2009. Patients were collected on either the COBE Spectra (Caridian BCT, Lakewood, CO) cell separator (n = 85) or Fresenius AS (Fresenius Kabi AG, Bad Homburg, Germany) 104 cell separator (n = 74) and mobilized with granulocyte-colony stimulating factor (G-CSF) alone (n = 47), G-CSF and Plerixafor (n = 36), or G-CSF and chemotherapy (n = 76). Patient characteristics (including age, weight, number of collections, volume processed, disease type, and mobilization strategy) did not differ significantly between the COBE and Fresenius cohorts, and adverse effects from infusion were similar except for 3 of 159 patients who experienced seizures upon infusion of PBSC; all 3 were collected on the COBE and had PBSC product white blood cell (WBC) counts of 590 × 10(3)/μL or above. We prospectively correlated WBC counts midcollection, with final WBC counts to identify products with high WBC concentration during cytapheresis. Fifty-one patients had 66 cytapheresis procedures using the COBE, with WBC counts midway and at the end of collection of 287 × 10(3) ± 150/μL and 273 × 10(3) ± 144/μL, respectively. Mid-WBC therefore correlated with WBC at the end of the collection. Finally, we prospectively collected mid-WBC from 65 patients who underwent 80 PBSC collections between June 2009 and January 2010 to identify products with midcollection WBC concentration >450 × 10(3)/μL. In those cases, additional autologous plasma was collected at the time of collection to dilute the final product before cryopreservation. Patients who received diluted products experienced no delays in engraftment and no additional seizure episodes occurred.
输注自体外周血干细胞 (PBSC) 引起的癫痫发作较为罕见。我们有 3 例患者在输注自体 PBSC 时出现癫痫发作，促使我们重新审查细胞治疗和细胞分离方案和程序。我们回顾性分析了 2006 年 1 月至 2009 年 7 月间采集的 159 例成年患者。患者分别在 COBE Spectra（Caridian BCT，Lakewood，CO）细胞分离机（n = 85）或 Fresenius AS（Fresenius Kabi AG，Bad Homburg，Germany）104 细胞分离机（n = 74）上采集，采用粒细胞集落刺激因子（G-CSF）单药（n = 47）、G-CSF 和普乐沙福（n = 36）或 G-CSF 和化疗（n = 76）进行动员。COBE 和 Fresenius 两组患者的特征（包括年龄、体重、采集次数、处理体积、疾病类型和动员策略）无显著差异，输注不良反应除 3 例 159 例患者在输注 PBSC 时出现癫痫发作外，其他也无显著差异；这 3 例均在 COBE 上采集，且 PBSC 产品白细胞（WBC）计数在 590×10(3)/μL 或以上。我们前瞻性地比较了采集过程中的白细胞（WBC）计数和采集结束时的白细胞（WBC）计数，以识别细胞分离过程中白细胞（WBC）浓度较高的产品。51 例患者使用 COBE 进行了 66 次细胞分离术，采集过程中、采集结束时的白细胞（WBC）计数分别为 287×10(3) ± 150/μL 和 273×10(3) ± 144/μL。因此，采集过程中的白细胞（WBC）计数与采集结束时的白细胞（WBC）计数相关。最后，我们前瞻性地采集了 65 例患者在 2009 年 6 月至 2010 年 1 月间 80 次 PBSC 采集过程中的采集过程中的白细胞（WBC）计数，以识别采集过程中白细胞（WBC）浓度＞450×10(3)/μL 的产品。在这些情况下，在冷冻保存前，在采集时额外采集患者自身的血浆来稀释最终产品。接受稀释产品的患者未出现延迟植入，也未发生额外的癫痫发作。
