Cryopreservation of Hematopoietic Stem Cells for Pediatric Autologous Stem Cell Transplantation

Background and Objectives: Dimethylsulfoxide(DMSO) is gold standard for cryopreservation of hematopoietic progenitor cells (HPC) to reconstitute hematopoiesis in autologous stem cell transplants (auto-HSCT). Higher DMSO-related adverse effects (AEs) are reported in pediatric patients due to lower body weight with the recommended maximal dose of 1g/kg bodyweight. This study compares adding Hhydroxyethyl starch Vs Pentastarch to DMSO in order to reduce the DMSO related adverse effects. Adding a non-permeating cryoprotectant like Hydroxyethyl starch (HES) lowers DMSO concentration. HES is known to cause pruritus and nephrotoxicity. Pentastarch has lower molecular weight hence faster renal elimination with fewer reported AEs. Adding a non-permeating cryoprotectant like Hydroxyethyl starch (HES) lowers DMSO concentration. Methods: This study is a single-centre retrospective-comparative analysis from October 2022 to February 2024, comparing cryopreservation outcomes using standard cryoprotectant-DMSO+ HES+albumin solution (CPS-1) with pentastarch+albumin+DMSO solution (CPS-2). During the study period, 20 pediatric patients who underwent auto-HSCT requiring cryopreserved HPC-A were included. Results: Average CD34+ recovery with CPS-1 and CPS-2 were 86.58±13.42 and 87.5±13.2% (P-value=0.879). Median time to neutrophil engraftment was comparable (10 days) and no significant difference in platelet engraftment was observed, median 13.5 and 15 days with CPS-1 and CPS-2. Post-cryopreservation product volume was lesser with CPS-2 compared to CPS-1 (271±34.77ml and 78±24.7; P< 0.0001). Mean DMSO volume in CPS-2 was significantly lower than in CPS-1 (7.5±2.63ml and 13.55±1.83ml; P