Engraftment Syndrome after Allogeneic Hematopoietic Cell Transplantation Predicts Poor Outcomes

被引:60
作者
Chang, Lawrence [1 ]
Frame, David [2 ]
Braun, Thomas [3 ]
Gatza, Erin [1 ]
Hanauer, David A. [4 ,5 ]
Zhao, Shuang [6 ]
Magenau, John M. [7 ]
Schultz, Kathryn [8 ]
Tokala, Hemasri [9 ]
Ferrara, James L. M. [1 ]
Levine, John E. [1 ]
Reddy, Pavan [7 ]
Paczesny, Sophie [10 ]
Choi, Sung Won [1 ]
机构
[1] Univ Michigan, Blood & Marrow Transplantat Program, Dept Pediat, Div Pediat Hematol Oncol, Ann Arbor, MI 48109 USA
[2] Univ Michigan, Coll Pharm, Ann Arbor, MI 48109 USA
[3] Univ Michigan, Dept Biostat, Ann Arbor, MI 48109 USA
[4] Univ Michigan, Div Gen Pediat, Dept Pediat, Ann Arbor, MI 48109 USA
[5] Univ Michigan, Informat Core, Ctr Comprehens Canc, Ann Arbor, MI 48109 USA
[6] Univ Michigan, Sch Med, Ann Arbor, MI 48109 USA
[7] Univ Michigan, Dept Internal Med, Div Hematol Oncol, Blood & Marrow Transplantat Program, Ann Arbor, MI 48109 USA
[8] Rush Univ, Med Ctr, Dept Pharm, Chicago, IL 60612 USA
[9] Michigan State Univ, Dept Internal Med, E Lansing, MI 48824 USA
[10] Indiana Univ, Dept Pediat Hematol Oncol, Indianapolis, IN 46204 USA
基金
美国国家卫生研究院;
关键词
Engraftment syndrome; Hematopoietic cell transplantation; Cytokine storm; CORD-BLOOD TRANSPLANTATION; VERSUS-HOST-DISEASE; CAPILLARY LEAK SYNDROME; RISK-FACTORS; DIAGNOSTIC-CRITERIA; BONE-MARROW; MANIFESTATIONS; SURVIVAL; LEUKEMIA; GVHD;
D O I
10.1016/j.bbmt.2014.05.022
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
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 10 days (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 2 years (38% versus 19%, P < .001) compared with non-ES patients, resulting in lower overall survival at 2 years (38% versus 54%, P < .001). There was no significant difference in relapse at 2 years (26% versus 31%, P = .772). 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. (C) 2014 American Society for Blood and Marrow Transplantation.
引用
收藏
页码:1407 / 1417
页数:11
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