High incidence of haemophagocytic syndrome following umbilical cord blood transplantation for adults

Abstract

Umbilical cord blood transplantation (CBT) is an alternative allogeneic haematopoietic stem cell transplantation (HSCT) strategy for patients with haematological diseases who do not have a matched related or unrelated donor and who need urgent transplantation. The value of CBT using myeloablative preparative regimens has already been confirmed among paediatric and adult patients (Laughlin et al, 2004;Rocha et al, 2004;Takahashi et al, 2004). However, conventional myeloablative preparative regimens are associated with significant morbidity and mortality, particularly in older patients or in those who have experienced extensive prior therapy or organ dysfunction associated with transplantation-related mortality. Various reduced-intensity preparative regimens that have been applied to such patients by several groups, including the authors of the present study, have proven feasible (Barker et al, 2003(Barker et al, , 2005Chao et al, 2004;Jacobsohn et al, 2004;Miyakoshi et al, 2004Miyakoshi et al, , 2007Yuji et al, 2005;Misawa et al, 2006;Ballen et al, 2007;Brunstein et al, 2007;Komatsu et al, 2007;Uchida et al, 2008).

Etoposide-containing conditioning regimen reduces the occurrence of hemophagocytic lymphohistiocytosis after SCT

“…Although some studies have described HLH occurring after SCT, there are few data regarding risk factors for HLH after SCT. Takagi et al 7 reported that fewer infused CD34 þ cells are a significant risk factor for the development of HLH, and Aldelkefi et al 6 reported that HLH after SCT was observed in many patients with allogeneic SCT and AA. Unfortunately, multicenter analysis did not include data on CD34 þ cells in our study.…”

“…[6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24] The frequency of HLH after SCT was reported as 4.1% in patients who had undergone autologous and allogeneic SCT 6 and was reported as 16.8% in patients who underwent CBT. 7 In the present study, the cumulative incidence of HLH was 4.3% in all patients and was 5.8% in patients who underwent CBT. Although some studies have described HLH occurring after SCT, there are few data regarding risk factors for HLH after SCT.…”

“…We used the criteria for HLH after SCT that were described by Takagi et al 7 A diagnosis of SCT-HLH required both major criteria, or one major and all four minor criteria. The first major criterion was engraftment failure, delayed engraftment or secondary engraftment failure after SCT, and the second major criterion was histopathological evidence of hemophagocytosis.…”

“…It is characterized by severe clinical manifestations and high mortality. [4][5][6][7] Despite current therapeutic approaches, outcomes remain poor. The present study analyzed HLH after SCT in patients in Hokkaido prefecture in Japan.…”

A novel reduced-intensity umbilical cord blood transplantation using a recombinant G-CSF combined with high-dose Ara-C for active myeloid malignancies

“…The risk factors for graft failure might depend on inappropriate conditioning, active disease, a small number of infused cells and unsuitable prophylaxis for GVHD. 39 Concomitant uncontrolled preengraftment immune reaction 26 and hemophagocytic syndrome 40 are frequently observed in CBT, and thus they are also important risk factors for graft failure. The median nucleated cell count of the cord blood used in our study was 2.6 × 10 7 /kg without particular selection of cord blood with a high nucleated cell count, in accordance with other researchers (Table 3).…”