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Engraftment syndrome after allogeneic hematopoietic cell transplantation predicts poor outcomes.

TitleEngraftment syndrome after allogeneic hematopoietic cell transplantation predicts poor outcomes.
Publication TypeJournal Article
Year of Publication2014
AuthorsChang, 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, SWon
JournalBiol Blood Marrow Transplant
Date Published2014 Sep

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.

Alternate JournalBiol. Blood Marrow Transplant.
PubMed ID24892262
PubMed Central IDPMC4142041
Grant List1K23AI091623 / AI / NIAID NIH HHS / United States
K23 AI091623 / AI / NIAID NIH HHS / United States
R01CA174667 / CA / NCI NIH HHS / United States
David Hanauer
University of Michigan Comprehensive Cancer Center at North Campus Reserach Complex
1600 Huron Parkway, Bldg 100, Rm 100 
Mailing Address: 2800 Plymouth Rd, NCRC 100-1004
Ann Arbor, MI 48109-2800 
Ph. (734) 764-8848 Fax. (734) 615-0517
Please acknowledge the Cancer Center Support Grant (P30 CA046592) when publishing manuscripts or abstracts that utilized the services of the University of Michigan's Comprehensive Cancer Center's Shared Resource: Cancer Informatics.
Suggested language: "Research reported in this [publication/press release] was supported by the National Cancer Institute of the National Institutes of Health under award number P30CA046592."

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