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

• Published in: Biology of blood and marrow transplantation 2013-04, Vol.19 (4), p.640-646
• Main Authors: Park, Meerim, Lee, Soo Hyun, Lee, Young Ho, Yoo, Keon Hee, Sung, Ki Woong, Koo, Hong Hoe, Kang, Hyoung Jin, Park, Kyung Duk, Shin, Hee Young, Ahn, Hyo Seop, Chung, Nak Gyun, Cho, Bin, Kim, Hack Ki, Koh, Kyung Nam, Im, Ho Joon, Seo, Jong Jin, Han, Dong Kyun, Baek, Hee Jo, Kook, Hoon, Hwang, Tai Ju, Lee, Eun Kyung, Hah, Jeong Ok, Lim, Yeon Jung, Jung, Hyun Joo, Park, Jun Eun, Jang, Moon Ju, Chong, So Young, Oh, Doyeun
• Format: Article
• Language: English
• Subjects: Acute Disease; Adolescent; Adrenal Cortex Hormones - therapeutic use; Adult; Aged; Child; Child, Preschool; Cord Blood Stem Cell Transplantation; Cord blood transplantation; Female; Graft Rejection - prevention & control; Graft Survival - immunology; Graft vs Host Disease - immunology; Graft vs Host Disease - mortality; Graft vs Host Disease - prevention & control; Graft vs Host Disease - therapy; Hematology, Oncology and Palliative Medicine; Humans; Infant; Male; Middle Aged; Myeloablative Agonists - therapeutic use; Outcome; Pre-engraftment syndrome; Prognosis; Retrospective Studies; Risk factor; Severity of Illness Index; Skin - immunology; Skin - pathology; Survival Analysis; Syndrome; Transplantation Conditioning; Transplantation, Homologous; Unrelated Donors
• ISSN: 1083-8791; 1523-6536
• DOI: 10.1016/j.bbmt.2013.01.014

Abstract 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°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 107 /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.