title: Preengraftment syndrome after unrelated cord blood transplant is a strong predictor of acute and chronic graft-versus-host disease.
abstract: Preengraftment syndrome (PES) is a known complication following unrelated cord blood transplant (CBT) that has not been well characterized. We sought to determine the incidence and clinical outcome of PES among 326 patients <18 years of age who were prospectively enrolled on a multicenter CBT trial. All patients received a myeloablative (MA) transplant and a single cord blood unit (CBU). PES developed in 20% of the patients at a median of 10 days (range: 5-24). Patients receiving a CBU with a total nucleated cell (TNC) count of >5 x 10(7)/kg had significantly higher risk of developing PES (P = .02). There were significantly higher rates of grade II-V (P < .001), grade III-IV (P < .001) acute and chronic (P = .002) graft-versus-host disease (aGVHD, cGVHD) in those who developed PES. In a multivariate analysis, PES did not significantly affect overall survival (OS) (P = .38). We conclude that PES is common following CB transplant (CBT) and additional more intensive immune suppression might be considered to decrease the risk of developing aGVHD and cGVHD.
authors.affiliation: Pediatric Stem Cell Transplant Program, Vanderbilt University, Nashville, Tennessee 37232-2573, USA. Haydar.Frangoul@Vanderbilt.edu
authors.forename: Haydar
authors.initials: H
authors.lastname: Frangoul
authors.forename: Li
authors.initials: L
authors.lastname: Wang
authors.forename: Frank E
authors.initials: FE
authors.lastname: Harrell
authors.forename: Richard
authors.initials: R
authors.lastname: Ho
authors.forename: Jennifer
authors.initials: J
authors.lastname: Domm
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D001772:Blood Cell Count; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D036101:Cord Blood Stem Cell Transplantation / Q000009:adverse effects* / Q000706:statistics & numerical data; D016207:Cytokines / Q000378:metabolism; D004487:Edema / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D005260:Female; D005334:Fever / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D006086:Graft vs Host Disease / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000627:therapeutic use; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011446:Prospective Studies; D013577:Syndrome; D014019:Tissue Donors; D019172:Transplantation Conditioning
chemical_list: D016207:Cytokines; D007166:Immunosuppressive Agents