Engraftment syndrome after allogeneic hematopoietic cell transplantation predicts poor outcomes

Lawrence Chang, David Frame, Thomas Braun, Erin Gatza, David A. Hanauer, Shuang Zhao, John M. Magenau, Kathryn Schultz, Hemasri Tokala, James L M Ferrara, John E. Levine, Pavan Reddy, Sophie Paczesny, Sung Won Choi

Research output: Contribution to journalArticle

29 Citations (Scopus)

Abstract

Engraftment syndrome (ES), characterized by fever, rash, pulmonary edema, weight gain, liver and renal dysfunction, and/or encephalopathy, occurs at the time of neutrophil recovery after hematopoietic cell transplantation (HCT). In this study, we evaluated the incidence, clinical features, risk factors, and outcomes of ES in children and adults undergoing first-time allogeneic HCT. Among 927 patients, 119 (13%) developed ES at a median of 10days (interquartile range 9 to 12) after HCT. ES patients experienced significantly higher cumulative incidence of grade 2 to 4 acute GVHD at day 100 (75% versus 34%, P<.001) and higher nonrelapse mortality at 2years (38% versus 19%, P<.001) compared with non-ES patients, resulting in lower overall survival at 2years (38% versus 54%, P<.001). There was no significant difference in relapse at 2years (26% versus 31%, P=72). Suppression of tumorigenicity 2, interleukin 2 receptor alpha, and tumor necrosis factor receptor 1 plasma biomarker levels were significantly elevated in ES patients. Our results illustrate the clinical significance and prognostic impact of ES on allogeneic HCT outcomes. Despite early recognition of the syndrome and prompt institution of corticosteroid therapy, outcomes in ES patients were uniformly poor. This study suggests the need for a prospective approach of collecting clinical features combined with correlative laboratory analyses to better characterize ES.

Original languageEnglish
Pages (from-to)1407-1417
Number of pages11
JournalBiology of Blood and Marrow Transplantation
Volume20
Issue number9
DOIs
StatePublished - 2014

Fingerprint

Cell Transplantation
Interleukin-2 Receptor alpha Subunit
Tumor Necrosis Factor Receptors
Incidence
Brain Diseases
Pulmonary Edema
Exanthema
Weight Gain
Liver Diseases
Adrenal Cortex Hormones
Neutrophils
Fever
Biomarkers
Kidney
Recurrence
Survival
Mortality

Keywords

  • Cytokine storm
  • Engraftment syndrome
  • Hematopoietic cell transplantation

ASJC Scopus subject areas

  • Transplantation
  • Hematology

Cite this

Engraftment syndrome after allogeneic hematopoietic cell transplantation predicts poor outcomes. / Chang, Lawrence; Frame, David; Braun, Thomas; Gatza, Erin; Hanauer, David A.; Zhao, Shuang; Magenau, John M.; Schultz, Kathryn; Tokala, Hemasri; Ferrara, James L M; Levine, John E.; Reddy, Pavan; Paczesny, Sophie; Choi, Sung Won.

In: Biology of Blood and Marrow Transplantation, Vol. 20, No. 9, 2014, p. 1407-1417.

Research output: Contribution to journalArticle

Chang, L, Frame, D, Braun, T, Gatza, E, Hanauer, DA, Zhao, S, Magenau, JM, Schultz, K, Tokala, H, Ferrara, JLM, Levine, JE, Reddy, P, Paczesny, S & Choi, SW 2014, 'Engraftment syndrome after allogeneic hematopoietic cell transplantation predicts poor outcomes', Biology of Blood and Marrow Transplantation, vol. 20, no. 9, pp. 1407-1417. https://doi.org/10.1016/j.bbmt.2014.05.022
Chang, Lawrence ; Frame, David ; Braun, Thomas ; Gatza, Erin ; Hanauer, David A. ; Zhao, Shuang ; Magenau, John M. ; Schultz, Kathryn ; Tokala, Hemasri ; Ferrara, James L M ; Levine, John E. ; Reddy, Pavan ; Paczesny, Sophie ; Choi, Sung Won. / Engraftment syndrome after allogeneic hematopoietic cell transplantation predicts poor outcomes. In: Biology of Blood and Marrow Transplantation. 2014 ; Vol. 20, No. 9. pp. 1407-1417.
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