title: Peri-engraftment syndrome in allogeneic hematopoietic SCT.
abstract: Engraftment syndrome (ES) and pre-engraftment syndrome (pre-ES) are both inflammatory conditions that occur after hematopoietic SCT (HSCT) and are characterized by non-infectious fever and skin rash. Although the pathogenesis is not fully understood, both syndromes are similar, and could be defined as a new clinical syndrome, named as peri-engraftment syndrome (peri-ES). We retrospectively analyzed the clinical records in 176 pediatric patients, following allogeneic HSCT. We utilized the definition of ES by Spitzer as the diagnostic criteria, excluding 'within 96 h of engraftment' criteria. Thirty cases developed peri-ES with a cumulative incidence of 17.0%. High cumulative incidence (50%) was seen in patients who underwent a double-unit cord blood transplantation (DUCBT; P<0.01). Clinical findings of peri-ES are similar, regardless of the onset day, and encephalopathy was the most severe complication. In the DUCBT cohort, the use of TBI and early complete chimerism (≤ day 21) were identified as risk factors that predispose the development of peri-ES. We determined that both, ES and pre-ES, might have similar causes, which could be included in peri-ES. Particularly, it occurred more in DUCBT patients, which means that not only neutrophil engraftment but also immune reactions within the two units might contribute to peri-ES.
authors.affiliation: Division of Hematology/Oncology, Department of Pediatrics, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea.
authors.forename: K T
authors.initials: KT
authors.lastname: Hong
authors.forename: H J
authors.initials: HJ
authors.lastname: Kang
authors.forename: N H
authors.initials: NH
authors.lastname: Kim
authors.forename: M S
authors.initials: MS
authors.lastname: Kim
authors.forename: J W
authors.initials: JW
authors.lastname: Lee
authors.forename: H
authors.initials: H
authors.lastname: Kim
authors.forename: K D
authors.initials: KD
authors.lastname: Park
authors.forename: H Y
authors.initials: HY
authors.lastname: Shin
authors.forename: H S
authors.initials: HS
authors.lastname: Ahn
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D036101:Cord Blood Stem Cell Transplantation; D005076:Exanthema / Q000453:epidemiology / Q000209:etiology / Q000276:immunology / Q000473:pathology / Q000503:physiopathology; D005260:Female; D005334:Fever / Q000453:epidemiology / Q000209:etiology / Q000276:immunology / Q000473:pathology / Q000503:physiopathology; D006085:Graft Survival / Q000276:immunology*; D019337:Hematologic Neoplasms / Q000453:epidemiology / Q000276:immunology / Q000473:pathology / Q000628:therapy; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D008499:Medical Records; D009504:Neutrophils / Q000276:immunology / Q000473:pathology; D012189:Retrospective Studies; D012307:Risk Factors; D013577:Syndrome; D018183:Transplantation Chimera / Q000276:immunology; D014184:Transplantation, Homologous