Orange Interventions for Symptoms Associated With Dimethyl Sulfoxide During Stem Cell Reinfusions

Background: For over 2 decades, oncology nurses at a regional comprehensive cancer center offered sliced oranges to patients during the reinfusion of autologous hematopoietic progenitor cells (HPCs) to relieve symptoms associated with the preservative dimethyl sulfoxide (DMSO). Objective: This randomized pilot study examined feasibility and efficacy of sliced orange intervention (OI), orange aromatherapy intervention (OAI), or deep breathing (control) to address unpleasant adverse effects during HPC infusion. Methods: Orange intervention sniffed or tasted a quartered orange, OAI sniffed orange aromatherapy, and control took deep breaths. Perceived "symptom intensity" for tickle/cough urge, nausea, retching, and perceived "relief" were measured on 0- to 10-point numerical scales. Results: Sixty of 72 eligible patients consented to participate and were randomized to OI (n = 19), OAI (n = 23), or control (n = 18). Study personnel successfully administered study procedures. Over the course of 2 bags of cells infused, the OI group reported significantly greater relief with the intervention (P = .032). Among participants less than 90 kg, OI group reported significantly lower symptom intensity (P = .012). Conclusions: Results suggest a feasible protocol and potential efficacy of sliced oranges for treating symptoms associated with DMSO-preserved stem cells. Study procedures provide a tested protocol for future studies. Follow-up study is warranted to confirm these findings and evaluate other treatment options. Implications for Practice: Oranges offer a simple, noninvasive intervention for relieving symptoms associated with DMSO preservative during autologous HPC infusion.