ACUTE HYPERTENSIVE CRISIS DURING INFUSION OF HEMATOPOIETIC PROGENITOR CELLS FROM MATCHED UNRELATED DONORS: IDENTIFICATION OF PREDICTIVE FACTORS AND OPTIMAL TREATMENT.

Acute hypertensive crisis during autologous hematopoietic progenitor cell (HPC) infusions using DMSO is widely reported, but the literature is silent regarding this event during infusions of HPC from matched unrelated donors (MUD). MUD-HPC infusions are often given by evening nursing staff when there is less clinical support in the hospital, and treatment varies with physician preference. Identification of predictive factors, and of optimal treatment may lead to improved outcomes. To identify predictive factors for the development of acute hypertensive crisis and to develop best treatment pathways. A retrospective chart review of 97 adult patients receiving MUD-HPC infusions from October 2003 - September 2004 was done. A retrospective chart review of 97 consecutive patients receiving MUD HPC infusions was completed. Demographic, clinical and laboratory factors were evaluated for the occurrence of hypertensive crisis using regression analysis. This analysis was limited to patients receiving HPC-marrow because only 2 of 20 cases occurred among patients receiving peripheral blood stem cell infusions. Hypertension crisis was defined as SBP >160, DBP >100 or a symptomatic increases in BP of 20 mm HG > baseline On univariate analysis, volume infused (adjusted for weight), elevated creatinine (>1.0mg/dl) and BUN levels above the median (>15mg/dl) were significant predictors. Because of high correlation between BUN and creatinine, only BUN was considered in multivariate analysis (higher precision associated with the estimate). Patients receiving high volume infusions with an elevated BUN were at the greatest risk (62%), followed by patients receiving high volume infusions and low BUN (28%), and then by patients receiving low volume and high BUN (17%). There were no cases of hypertension among the 18 patients who received low volumes and had a low BUN. Medical treatment during hypertensive episodes varied by best responses was seen with combined use of IV antihypertensive agents and diuretics. These findings suggest that volume reduction of HPC-M may decrease the incidence of acute hypertensive crisis during MUD infusions. [ABSTRACT FROM AUTHOR]