Engraftment syndrome after autologous peripheral blood progenitor cell transplantation in pediatric patients: a prospective evaluation of risk factors and outcome

Abstract

Summary:We prospectively analyzed the incidence, risk factors and outcome of engraftment syndrome (ES) in 112 patients undergoing autologous peripheral blood progenitor cell transplantation with different malignancies between January 1999 and December 2003. The median age was 8 years (range 1-18). There were 73 males. There were 37 hematological neoplasias and 75 solid tumors. Disease status at transplantation was early in 49, intermediate in 15 and 48 in advanced phase. The median CD34 þ cells infused was 4.6 Â 10 6 /kg. With a median follow-up of 23 months (1-116 months), 38 patients developed ES. The cumulative incidence of ES was 34.574.5% and the event-free survival was 58.3712%. There were no differences in the causes of death between patients with or without ES. A high number of CD34 þ cells/kg infused, patients transplanted in early phase, the type of malignancy (solid tumor) and conditioning regimens other than busulfan based were significantly associated with ES in a multivariate analysis.

Peri-engraftment syndrome in allogeneic hematopoietic SCT

“…In particular, encephalopathy occurred in the peri-ES patients more frequently (20%, 6 of 30 patients) than in the previous studies (0-11%). [2][3][4][5] Moreover, encephalopathy tends to develop later, after the fulfillment of the diagnostic criteria, which means that early detection and prompt treatment were crucial to minimizing the morbidity of neurological problems. Although human herpes virus 6 reactivation was known as a cause of opportunistic infections after HSCT, 19 we could not screen for this virus in cerebrospinal fluid routinely, due to the patients' unstable clinical condition.…”

“…Furthermore, other unique criteria were also applied, owing to the diversity of clinical findings of ES. 3,5,6 For this reason, it is important to know which criteria were used to evaluate ES.…”

“…Because of the various diagnostic criteria of ES, however, the incidence, risk factors and clinical outcomes of the ES remain multifarious. [2][3][4][5][6][7] Furthermore, pre-engraftment syndrome (pre-ES), which is more emphasized with a fever, rash and an occurrence in the pre-engraftment period, has been described and considered different from ES. [8][9][10][11] We retrospectively analyzed the clinical records of 176 patients following allogeneic HSCT.…”

SCT without growth factor in multiple myeloma: engraftment kinetics, bacteremia and hospitalization

“…In an assessment of the toxicity of filgrastim on normal volunteers, adverse events included bone pain, with 6% experiencing grade 3-4 toxicities and 0.6% having serious and unexpected toxicity, possibly related to the rapid increase in WBCs with growth factor stimulation and cytokine-induced noncardiogenic pulmonary edema. 10 Avoidance of these adverse effects by eliminating the use of growth factors would therefore be beneficial to patients.…”

“…7 Complications after the administration of granulocyte hematopoietic growth factors are rare, but acute respiratory distress syndrome 8 has been reported, as have allergic-type reactions 9 including dyspnea, wheezing and hypotension. Alveolar hemorrhages have been reported, and the engraftment syndrome, 10 related to a rapid increase in the leukocyte count, may occur. 11 Splenic rupture, including rare fatal cases, has been reported; 12 bone pain is seen in approximately one-fourth of patients, 13 as is cutaneous vasculitis.…”