Pre-engraftment syndrome after double-unit cord blood transplantation: a distinct syndrome not associated with acute graft-versus-host disease.
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 degrees C (101 degrees 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 degrees C [102.2 degrees 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, 1mg/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.
Allogeneic Bone Marrow Transplantation Service, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA.
Kevin J
KJ
Patel
Robert D
RD
Rice
Rebecca
R
Hawke
Michelle
M
Abboud
Glenn
G
Heller
Andromachi
A
Scaradavou
James W
JW
Young
Juliet N
JN
Barker
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D036101:Cord Blood Stem Cell Transplantation / Q000009:adverse effects*; D005076:Exanthema / Q000150:complications* / Q000188:drug therapy; D005260:Female; D005335:Fever of Unknown Origin / Q000150:complications* / Q000188:drug therapy; D006084:Graft Rejection; D006086:Graft vs Host Disease / Q000175:diagnosis; D019337:Hematologic Neoplasms / Q000150:complications* / Q000628:therapy*; D006801:Humans; D053208:Kaplan-Meier Estimate; D007958:Leukocyte Count; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use; D008875:Middle Aged; D009504:Neutrophils / Q000473:pathology; D011183:Postoperative Complications / Q000188:drug therapy; D012189:Retrospective Studies; D013577:Syndrome; D019172:Transplantation Conditioning; D016896:Treatment Outcome; D055815:Young Adult
D008775:Methylprednisolone