21. Adverse events after autologous hematopoietic stem cell transplantation in autoimmune patients

Nguyen Thi Duyen, Mai Van Vien, Nguyen Thi Minh Phuong, Le Thi Thu Nga, Nguyen Thanh Binh

Main Article Content

Abstract

A prospective, cross-sectional descriptive study on 8 autoimmune patients receiving autologous hematopoietic stem cell transplantation at 108 Military Central Hospital with the aim of evaluating adverse events after transplantation. Adverse events were determined according to the CTCAE 5.0 guidelines 2017. The results showed that during the stem cell mobilization and harvesting phase, the adverse events were fatigue (100%), anorexia (87.5%), nausea (75%), vomiting (25%), abdominal pain (12.5%), bone pain (87.5%), decreased hemoglobin (50%), leukopenia, neutropenia and platelets were 62.5%, ALT increased (12.5%). Adverse events were mild and transient, grade 1 to 2 according to CTCAE 5.0. In the conditioning treatment phase, there were adverse events including fatigue (100%), anorexia (100%), nausea (87.5%), vomiting (87.5%), oral mucositis (25%), diarrhea (62.5%), abdominal pain (37.5%), bone pain (75%), febrile neutropenia (87.5%); cytopenia was found in 100% of patients. Liver function (AST and ALT) slightly increased at grade 1 and 2 (accounting for 75%), not required treatment. Renal function is not affected. One patient (12.5%) had sepsis caused by Klebsiella pneumoniae in the period of cytopenia, and CMV, BK virus reactivation, all responded to treatment. There were no deaths related to stem cell transplantation.

Article Details

References

1. Snowden JA, Badoglio M, Labopin M, et al. Evolution, trends, outcomes, and economics of hematopoietic stem cell transplantation in severe autoimmune diseases. Blood Adv. 2017; 1(27): 2742-2755.
2. Daikeler T, Tichelli A, Passweg J. Complications of autologous hematopoietic stem cell transplantation for patients with autoimmune diseases. Pediatr Res. 2012; 71(4 Pt 2): 439-444. doi:10.1038/pr.2011.57.
3. Nagler A, Shimoni A. Conditioning. The EBMT Handbook: Hematopoietic Stem Cell Transplantation and Cellular Therapies. 7th ed. Springer; 2019. Accessed March 19, 2023. http://www.ncbi.nlm.nih.gov/books/NBK553926/.
4. Cho SY, Lee HJ, Lee DG. Infectious complications after hematopoietic stem cell transplantation: current status and future perspectives in Korea. Korean J Intern Med. 2018; 33(2): 256-276. doi:10.3904/kjim.2018.036.
5. Bride KL, Levy E, Wohlschlaeger A, et al. Infectious Complications and HSCT. Hematopoietic Stem Cell Transplantation for the Pediatric Hematologist/Oncologist. Springer International Publishing; 2018: 241-255.
6. Common Terminology Criteria for Adverse Events (CTCAE) https://ctep.cancer.gov/protocoldevelopment/electronic_applications/ctc.htm.
7. Alexander T, Greco R, Snowden JA. Hematopoietic Stem Cell Transplantation for Autoimmune Disease. Annu Rev Med. 2021; 72: 215-228.
8. Martin F, Lauwerys B, Houssiau FA, et al. Side-effects of intravenous cyclophosphamide pulse therapy. Lupus. 1997; 6(3): 254-257.
9. Karlin L, Darmon M, Thiéry G, et al. Respiratory status deterioration during G-CSF-induced neutropenia recovery. Bone Marrow Transplant. 2005; 36(3): 245-250.
10. Bạch Quốc Khánh. Nghiên cứu hiệu quả của ghép tế bào gốc tự thân điều trị bệnh đa u tủy xương và u lympho ác tính không Hodgkin. Trường Đại học Y Hà Nội. Luận án Tiến sỹ Y học.
11. Murata M, Harada M, Kato S, et al. Peripheral blood stem cell mobilization and apheresis: analysis of adverse events in 94 normal donors. Bone Marrow Transplant. 1999; 24(10): 1065-1071.
12. da Silva PSL, Passos RMA, Waisberg DR, et al. Serum sickness and severe acute renal failure after rabbit antithymocyte globulin treatment in aplastic anemia: a case report. J Pediatr Hematol Oncol. 2011; 33(1): 43-46.
13. The impact of antithymocyte globulin on short-term toxicity after allogeneic stem cell transplantation - PubMed. https://pubmed.ncbi.nlm.nih.gov/12235518/.
14. Bryant A, Atkins H, Pringle CE, et al. Myasthenia Gravis Treated With Autologous Hematopoietic Stem Cell Transplantation. JAMA Neurol. 2016; 73(6): 652-658.
15. Brinkman DMC, de Kleer IM, ten Cate R, et al. Autologous stem cell transplantation in children with severe progressive systemic or polyarticular juvenile idiopathic arthritis: long-term follow-up of a prospective clinical trial. Arthritis Rheum. 2007; 56(7): 2410-2421.
16. Farge D, Labopin M, Tyndall A, et al. Autologous hematopoietic stem cell transplantation for autoimmune diseases: an observational study on 12 years’ experience from the European Group for Blood and Marrow Transplantation Working Party on Autoimmune Diseases. Haematologica. 2010; 95(2): 284-292.