Pre-Engraftment Syndrome after Unrelated Cord Blood Transplantation: A Predictor of Engraftment and Acute Graft-versus-Host Disease

被引:43
作者
Park, Meerim [1 ]
Lee, Soo Hyun [2 ]
Lee, Young Ho [3 ]
Yoo, Keon Hee [2 ]
Sung, Ki Woong [2 ]
Koo, Hong Hoe [2 ]
Kang, Hyoung Jin [4 ]
Park, Kyung Duk [4 ]
Shin, Hee Young [4 ]
Ahn, Hyo Seop [4 ]
Chung, Nak Gyun [5 ]
Cho, Bin [5 ]
Kim, Hack Ki [5 ]
Koh, Kyung Nam [6 ]
Im, Ho Joon [6 ]
Seo, Jong Jin [6 ]
Han, Dong Kyun [7 ]
Baek, Hee Jo [7 ]
Kook, Hoon [7 ]
Hwang, Tai Ju [7 ]
Lee, Eun Kyung [8 ]
Hah, Jeong Ok [8 ]
Lim, Yeon Jung [9 ]
Jung, Hyun Joo [10 ]
Park, Jun Eun [10 ]
Jang, Moon Ju [11 ]
Chong, So Young [11 ]
Oh, Doyeun [11 ]
机构
[1] Chungbuk Natl Univ, Coll Med, Dept Pediat, Chonju, South Korea
[2] Sungkyunkwan Univ, Sch Med, Samsung Med Ctr, Dept Pediat, Seoul, South Korea
[3] Hanyang Univ, Coll Med, Med Ctr, Dept Pediat, Seoul 133791, South Korea
[4] Seoul Natl Univ, Coll Med, Canc Res Inst, Dept Pediat, Seoul, South Korea
[5] Catholic Univ Korea, Seoul St Marys Hosp, Dept Pediat, Seoul, South Korea
[6] Univ Ulsan, Coll Med, Dept Pediat, Asan Med Ctr,Childrens Hosp, Seoul, South Korea
[7] Chonnam Natl Univ, Sch Med, Hwasun Hosp, Dept Pediat, Kwangju, South Korea
[8] Yeungnam Univ, Dept Pediat, Taegu, South Korea
[9] Chungnam Natl Univ, Dept Pediat, Taejon, South Korea
[10] Ajou Univ, Sch Med, Dept Pediat, Suwon 441749, South Korea
[11] CHA Univ, CHA Bundang Med Ctr, Dept Internal Med, Songnam, South Korea
关键词
Pre-engraftment syndrome; Cord blood transplantation; Risk factor; Outcome; STEM-CELL TRANSPLANTATION; BONE-MARROW-TRANSPLANTATION; HEMATOLOGIC MALIGNANCIES; ADULT PATIENTS; ACUTE-LEUKEMIA; DONORS; OUTCOMES; INTERLEUKIN-8; EXPRESSION; RECIPIENTS;
D O I
10.1016/j.bbmt.2013.01.014
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Pre-engraftment syndrome (PES) is poorly characterized, and its clinical significance and the prognostic impact after unrelated cord blood transplantation (CBT) are unclear. To address these issues, we retrospectively analyzed the incidence, risk factors, and clinical outcomes of PES in unrelated CBT recipients. Data of 381 patients who received unrelated CBT from 18 medical centers in Korea were reviewed. PES was defined as unexplained fever >38.3 degrees C not associated with infection, and/or unexplained skin rash with or without evidence of fluid retention before neutrophil recovery. PES developed in 102 patients (26.8%) at a median of 7 days after CBT. Of these patients, 74 patients (72.5%) received intravenous corticosteroid at a median dose of 1 mg/kg/day, and of these, 95% showed clinical improvement. Risk factors for developing PES included low risk disease, myeloablative conditioning, graft-versus-host disease (GVHD) prophylaxis without methotrexate or corticosteroid, and >5.43 x 10(7)/kg infused nucleated cells. Absence of PES was one of the risk factors for graft failure in multivariate analysis. The cumulative incidence of grade II to grade IV acute GVHD by 100 days after CBT was higher in patients with PES than in those without PES (56.0% versus 34.4%, P < .01). PES was not associated with chronic GVHD, treatment-related mortality, relapse, or overall survival. PES seems to be common after CBT and may be associated with enhanced engraftment without significant morbidity. (C) 2013 American Society for Blood and Marrow Transplantation.
引用
收藏
页码:640 / 646
页数:7
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