Engraftment syndrome following hematopoietic stem cell transplantation

Abstract

Summary:During neutrophil recovery following hematopoietic stem cell transplantation, a constellation of symptoms and signs including fever, erythrodermatous skin rash, and noncardiogenic pulmonary edema often occur. These clinical findings have usually been referred to as engraftment syndrome, or, reflecting the manifestations of increased capillary permeability, capillary leak syndrome. While described most often following autologous stem cell transplantation, a similar clinical syndrome has been observed followed allogeneic stem cell transplantation. Distinction from graft-versus-host disease in the allogeneic setting however, has been difficult. Recent experience with non-myeloablative conditioning for stem cell transplantation, however, reveals that an engraftment syndrome independent of GVHD may occur. In some cases, this engraftment syndrome may be a manifestation of a host-versus-graft reaction (graft rejection). While cellular and cytokine interactions are believed to be responsible for these clinical findings, a distinct effector cell population and cytokine profile have not been defined. Engraftment syndromes are likely associated with an increased transplant-related mortality, mostly from pulmonary and associated multiorgan failure. Corticosteroid therapy is often dramatically effective for engraftment syndrome, particularly for the treatment of the pulmonary manifestations. A proposal for a more uniform definition of engraftment syndrome has been developed in order to allow for a reproducible method of reporting of this complication and for evaluating prophylactic and therapeutic strategies. Bone Marrow Transplantation (2001) 27, 893-898.

Case of engraftment syndrome appearing as scratch dermatitis

“…Engraftment syndrome (ES) presents with pyrexia, maculopapular eruption and edema during neutrophil recovery following hematopoietic stem cell transplantation 2. Here, we describe a case with scratch dermatitis encountered as a clinical manifestation of ES.…”

Inflammatory Markers in Patients after Hematopoietic Stem Cell Transplantation

“…There are no uniform classification criteria available for this complication. It is characterized by non-infectious fever, weight gain, an erythrodermatous skin rash, and non-cardiogenic pulmonary edema (Spitzer 2001). The reported incidence of ES has varied widely, ranging from 7 % (Edenfield et al 2000) to as high as 59 % (Lee et al 1995).…”

“…The reported incidence of ES has varied widely, ranging from 7 % (Edenfield et al 2000) to as high as 59 % (Lee et al 1995). This is thought to be due to a lack of common diagnostic criteria (Carreras et al 2010;Spitzer 2001). The lack of well-defined criteria for the diagnosis of ES has also likely influenced the analysis of risk factors for its occurrence (Spitzer 2001).…”

“…This is thought to be due to a lack of common diagnostic criteria (Carreras et al 2010;Spitzer 2001). The lack of well-defined criteria for the diagnosis of ES has also likely influenced the analysis of risk factors for its occurrence (Spitzer 2001). The pathogenesis of ES remains unknown but it is thought that the local and systemic injury seen is a result of pro-inflammatory cytokines released during neutrophil recovery.…”

“…The pathogenesis of ES remains unknown but it is thought that the local and systemic injury seen is a result of pro-inflammatory cytokines released during neutrophil recovery. Macrophage colony-stimulating factor, erythropoietin and products of neutrophil degranulation and oxidative metabolism, are also thought to be involved in the process (Spitzer 2001). Many cytokines have been implicated in the pathogenesis of ES; however, there has been no well-defined characterization of the cytokine profile on ES (Spitzer 2001).…”