Complications after bone marrow transplantation are manifestations of systemic inflammatory response syndrome

Abstract

Summary:Bone marrow transplantation has been established as a useful treatment for various hematological disorders and is now performed widely, but the mortality rate is still high due to various complications. A clear therapeutic policy for such complications has not yet been established because of their complex nature. We investigated whether the major complications occurring after bone marrow transplantation could be classified as aspects of the systemic inflammatory response syndrome. Subjects were 10 patients who developed severe complications after bone marrow transplantation (graft-versus-host disease, thrombotic microangiopathy, respiratory disorders, and cytomegalovirus interstitial pneumonitis) and 16 patients without complications. Their symptoms, serum cytokines, and factors related to vascular endothelial damage were compared before and after transplantation. Whereas all 10 patients who developed complications had fever in the aplastic phase after transplantation, 15 of the 16 patients without complications remained afebrile (P Ͻ 0.001, t-test). When compared with the patients who did not develop complications, the patients with complications also showed significantly higher cytokine levels during the recovery phase after transplantation (P Ͻ 0.0001, t-test). Thus, the patients with complications developed fever in the aplastic phase and showed an increase of cytokines during the recovery phase, which triggered the occurrence of vascular endothelial damage shown by factors such as the thrombomodulin and plasminogen activator inhibitor type 1. This sequence of events corresponds with that occurring during systemic inflammatory response syndrome, so many of the complications of bone marrow transplantation can be considered as manifestations of this syndrome. Bone Marrow Transplantation (2000) 26, 419-426.

Early-onset acute kidney injury is a poor prognostic sign for allogeneic SCT recipients

“…The period prior to stem-cell engraftment may involve the worst clinical condition of SCT recipients, associated with predispositions to serious infections, regimen-related toxicity and immunological stress, resulting in sepsis, and acute inflammatory response syndrome. 27 Accordingly, the incidence of AKI during this period may become a trigger of multiorgan failure, as AKI is often accompanied by a systemic excessive inflammatory response that involves the mechanisms of developing remote extra-renal organ dysfunction. 28,29 The occurrence of early AKI may be associated with a delay or failure of stem-cell engraftment, as the disease status of AKI might affect the function of Figure 1.…”

Engraftment syndrome: double-edged sword of hematopoietic cell transplants

“…Engraftment syndrome after transplantation TR Spitzer 34,35 Chang et al 9 reported increased levels of suppression of tumorigenicity, IL-2 receptor-alpha and TNF-receptor-1 levels in persons with ES similar to persons with acute GVHD. However, there is no unique or consistent pattern of cytokine abnormalities in persons with ES.…”

An autopsy case that manifested no convincing histological changes of severe renal failure after hematopoietic stem cell transplantation

“…First, 'conditioning-associated tubular injury' occurred, possibly due to the administration of a high amount of cyclophosphamide, as it is known to impair the uroepithelium through its toxic metabolite, acrolein [15]. Next, the inflammatory and cytokine cascade that accompanies the infused allogeneic stem cells affected kidney function [2,16,17], as the serum proinflammatory cytokine levels were highly increased in parallel with the increasing serum Cr levels. The pathophysiologic nature of the increased CRP remained conjectural, infectious inflammation or non-infectious inflammation or both, in this case.…”