Pre-engraftment syndrome after double-unit cord blood transplantation: A distinct syndrome not associated with acute graft-versus-host disease Journal Article


Authors: Patel, K. J.; Rice, R. D.; Hawke, R.; Abboud, M.; Heller, G.; Scaradavou, A.; Young, J. W.; Barker, J. N.
Article Title: Pre-engraftment syndrome after double-unit cord blood transplantation: A distinct syndrome not associated with acute graft-versus-host disease
Abstract: Pre-engraftment syndrome (PES) occurring after cord blood transplantation (CBT) is poorly characterized. We reviewed 52 consecutive double-unit CBT recipients treated for high-risk hematologic malignancies. PES was defined as unexplained fever >38.3 °C (101°F) not associated with infection and unresponsive to antimicrobials, and/or unexplained rash occurring before or at neutrophil recovery. CBT recipients (median age, 38 years; range, 3-66 years) received either myeloablative (MA; n = 36) or nonmyeloablative (NMA; n = 16) conditioning. Sixteen patients (31%) fulfilled PES criteria: 15 with fever (median at onset, 39 °C [102.2°F]), 13 of whom also had rash, and 1 with rash alone. The median onset was 9 days (range, 5-12 days) posttransplantation (a median of 14 days before neutrophil recovery). Sixteen patients (14 with PES and 2 with infection and possible PES) received intravenous methylprednisolone (median dose, 1 mg/kg; median duration, 3 days); 15 (94%) experienced resolution of fever within 24 hours. Recurrent PES (n = 3) resolved with retreatment. There was no association between the development of PES and the likelihood of sustained donor engraftment, speed of neutrophil recovery, grade II-IV acute graft-versus-host disease (aGVHD), day-180 treatment-related mortality (TRM), or survival. PES is common after CBT, precedes neutrophil recovery, is distinct from and does not predict for aGVHD, and responds promptly to short-course corticosteroid therapy. © 2010 American Society for Blood and Marrow Transplantation.
Keywords: adolescent; adult; child; controlled study; preschool child; school child; treatment outcome; aged; child, preschool; middle aged; retrospective studies; young adult; major clinical study; clinical feature; infection; neutrophil count; differential diagnosis; fever; rash; kaplan-meiers estimate; postoperative complications; acute graft versus host disease; cord blood stem cell transplantation; engraftment; hematologic malignancy; myeloablative conditioning; nonmyeloablative conditioning; hematologic neoplasms; syndrome; transplantation conditioning; neutrophils; methylprednisolone; leukocyte count; high risk population; graft rejection; graft survival; corticosteroid; cyclosporin a; graft vs host disease; mycophenolic acid 2 morpholinoethyl ester; granulocyte colony stimulating factor; exanthema; short course therapy; engraftment syndrome; pre engraftment syndrome; fever of unknown origin
Journal Title: Biology of Blood and Marrow Transplantation
Volume: 16
Issue: 3
ISSN: 1083-8791
Publisher: Elsevier Inc.  
Date Published: 2010-03-01
Start Page: 435
End Page: 440
Language: English
DOI: 10.1016/j.bbmt.2009.10.022
PUBMED: 19857590
PROVIDER: scopus
PMCID: PMC3096002
DOI/URL:
Notes: --- - "Export Date: 20 April 2011" - "CODEN: BBMTF" - "Source: Scopus"
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MSK Authors
  1. Glenn Heller
    370 Heller
  2. Kevin Patel
    2 Patel
  3. Juliet N Barker
    296 Barker
  4. Michelle Abboud
    15 Abboud
  5. James W Young
    297 Young
  6. Rebecca M Hawke
    12 Hawke
  7. Robert D Rice
    28 Rice