title: Pre-engraftment syndrome after unrelated cord blood transplantation: a predictor of engraftment and acute graft-versus-host disease.
abstract: Pre-engraftment syndrome (PES) is poorly characterized, and its clinical significance and the prognostic impact after unrelated cord blood transplantation (CBT) are unclear. To address these issues, we retrospectively analyzed the incidence, risk factors, and clinical outcomes of PES in unrelated CBT recipients. Data of 381 patients who received unrelated CBT from 18 medical centers in Korea were reviewed. PES was defined as unexplained fever >38.3°C not associated with infection, and/or unexplained skin rash with or without evidence of fluid retention before neutrophil recovery. PES developed in 102 patients (26.8%) at a median of 7 days after CBT. Of these patients, 74 patients (72.5%) received intravenous corticosteroid at a median dose of 1 mg/kg/day, and of these, 95% showed clinical improvement. Risk factors for developing PES included low risk disease, myeloablative conditioning, graft-versus-host disease (GVHD) prophylaxis without methotrexate or corticosteroid, and >5.43 x 10(7)/kg infused nucleated cells. Absence of PES was one of the risk factors for graft failure in multivariate analysis. The cumulative incidence of grade II to grade IV acute GVHD by 100 days after CBT was higher in patients with PES than in those without PES (56.0% versus 34.4%, P < .01). PES was not associated with chronic GVHD, treatment-related mortality, relapse, or overall survival. PES seems to be common after CBT and may be associated with enhanced engraftment without significant morbidity.
authors: Department of Pediatrics, Chungbuk National University College of Medicine, Cheongju, Korea.
authors: Meerim
authors: M
authors: Park
authors: Soo Hyun
authors: SH
authors: Lee
authors: Young Ho
authors: YH
authors: Lee
authors: Keon Hee
authors: KH
authors: Yoo
authors: Ki Woong
authors: KW
authors: Sung
authors: Hong Hoe
authors: HH
authors: Koo
authors: Hyoung Jin
authors: HJ
authors: Kang
authors: Kyung Duk
authors: KD
authors: Park
authors: Hee Young
authors: HY
authors: Shin
authors: Hyo Seop
authors: HS
authors: Ahn
authors: Nak Gyun
authors: NG
authors: Chung
authors: Bin
authors: B
authors: Cho
authors: Hack Ki
authors: HK
authors: Kim
authors: Kyung Nam
authors: KN
authors: Koh
authors: Ho Joon
authors: HJ
authors: Im
authors: Jong Jin
authors: JJ
authors: Seo
authors: Dong Kyun
authors: DK
authors: Han
authors: Hee Jo
authors: HJ
authors: Baek
authors: Hoon
authors: H
authors: Kook
authors: Tai Ju
authors: TJ
authors: Hwang
authors: Eun Kyung
authors: EK
authors: Lee
authors: Jeong Ok
authors: JO
authors: Hah
authors: Yeon Jung
authors: YJ
authors: Lim
authors: Hyun Joo
authors: HJ
authors: Jung
authors: Jun Eun
authors: JE
authors: Park
authors: Moon Ju
authors: MJ
authors: Jang
authors: So Young
authors: SY
authors: Chong
authors: Doyeun
authors: D
authors: Oh
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D036101:Cord Blood Stem Cell Transplantation; D005260:Female; D006084:Graft Rejection / Q000517:prevention & control; D006085:Graft Survival / Q000276:immunology*; D006086:Graft vs Host Disease / Q000276:immunology* / Q000401:mortality / Q000517:prevention & control / Q000628:therapy*; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D019653:Myeloablative Agonists / Q000627:therapeutic use; D011379:Prognosis; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012867:Skin / Q000276:immunology / Q000473:pathology; D016019:Survival Analysis; D013577:Syndrome; D019172:Transplantation Conditioning; D014184:Transplantation, Homologous; D061349:Unrelated Donors
chemical_list: D000305:Adrenal Cortex Hormones; D019653:Myeloablative Agonists