Ventricular Bigeminy During Cryopreserved Autologous Hematopoietic Stem Cell Infusion.

SESSION TITLE: Critical Care Case Report Posters IIISESSION TYPE: Affiliate Case Report PosterPRESENTED ON: Tuesday, October 28, 2014 at 01:30 PM - 02:30 PMINTRODUCTION: Cryopreserved hematopoietic stem cell transfusions are sometimes associated with transient and benign reactions like nausea, flushing and bradycardia. We present a patient who developed ventricular bigeminy during the infusion of peripheral blood stem cell transplant (PBSCT).CASE PRESENTATION: A 69-year-old man with a history of multiple myeloma, peripheral neuropathy and intermittent palpitations presented for autologous PBSCT after receiving two days of melphalan conditioning. Two months prior, he received 9 cycles of lenalidomide, dexamethasone and bortezomib. For his history of palpitations, he had undergone 24-hour Holter monitoring a day prior to presentation, which showed 2133 (1.76%) supraventricular ectopics, 2 supraventricular tachycardia runs, 773 (0.64%) ventricular ectopics and 9 ventricular bigeminy runs. A recent echocardiogram was only positive for grade 1/4 diastolic dysfunction. A baseline ECG showed sinus rhythm with 1st degree atrioventricular (AV) block. During PBSCT infusion, the patient was noted to be bradycardic on the pulse oximeter, but was asymptomatic. Vital signs were: temperature 36.2 C, pulse 47/min, blood pressure 137/78 mmHg, respirations 16/min, and oxygen saturation 99% on room air. Aside from a regular, bradycardic pulse, physical exam was unrevealing. The ECG showed new ventricular bigeminy (Figure 1) and a critical care consult was called. Serum potassium and magnesium were normal. A dimethyl sulfoxide (DMSO) reaction was suspected and the infusion was paused. About 1 minute later, the bigeminy reverted to sinus rhythm. The infusion was resumed at a slower rate and bigeminy soon recurred. The patient remained asymptomatic and the infusion was completed. An ECG repeated several hours later was similar to baseline (Figure 2). The patient was discharged after an in-patient cardiac evaluation.DISCUSSION: DMSO is used as a cryopreservative for PBSCT. Infusion-related nausea, headaches and vomiting are common and transient reactions reported in association with DMSO-containing PBSCT (1). Cardiac events, such as arrhythmias (2), cardiac arrest (3) or coronary spasm are rare. Our case highlights the arrhythmogenic potential of cryopreserved PBSCT products, most likely resulting from DMSO.CONCLUSIONS: Patients with pre-existing rhythm abnormalities may benefit from cardiac monitoring during cryopreserved PBSCT infusions.Reference #1: Cox MA et al. Cell Tissue Bank. 2012;13:203-15.Reference #2: Zenhausern R et al. Ann Hematol. 2000;79:523-6.Reference #3: Rapoport AP et al. Bone Marrow Transplant. 1991;7:401-3.DISCLOSURE: The following authors have nothing to disclose: Sumedh Hoskote, James OnigkeitDimethyl sulfoxide (DMSO) is commonly used as a cryopreservative for hematopoietic stem cells. However, the US FDA has not approved it for this purpose. Our case describes a potential adverse effect that may be related to DMSO.