Recurrent neurologic symptoms during peripheral stem cell apheresis in two patients with intracranial metastases

Leukapheresis recently has been used to harvest circulating hematopoietic stem cells for autologous transplantation. This technique is especially useful when involvement of the bone marrow by tumor precludes its use as a source for stem cells. Thirty-five patients have had peripheral blood stem cells harvested for transplantation by this technique at our institution. Two patients with adenocarcinoma of the breast developed severe headaches during apheresis, and both were found to have extensive intracranial metastases. For one patient, the pain was excruciating and associated with hypotension at the end of each collection phase of the apheresis procedure and resolved approximately 5 minutes after reinfusion of the patient's red cells and plasma. Subsequently this patient had a documented subdural hydroma. Following an apheresis procedure, while receiving local low dose thrombolytic therapy for thrombosis of the brachiocephalic vein, she suffered a fatal intracerebral hemorrhage. The second patient had a severe exacerbation of a headache of recent onset. Leukapheresis was abandoned when extensive intracranial disease was documented. We conclude that recurrent neurologic symptoms, especially cranial pain, during the withdrawal phase of intermittent flow apheresis may predict intracranial pathology in patients. Peripheral stem cell apheresis and lymphocytapheresis are bringing patients with metastatic malignancies to the apheresis department with increasing frequency, and the apheresis staff must be alert to previously undescribed complications of apheresis.