title: Pulmonary manifestations of the pre-engraftment syndrome after umbilical cord blood transplantation.
abstract: Pre-engraftment syndrome (PES) is a condition occurring after umbilical cord blood transplantation (UCBT) characterized by fever and erythematous skin rash prior to neutrophil engraftment. We sought to determine the incidence and characterize the pulmonary manifestations of PES. A retrospective review of patients who underwent UCBT at the University of Kansas Medical Center over a 5-year period was performed. Data collected included patient baseline characteristics, presence of PES, pulmonary findings, treatments, and survival. Forty-four patients underwent UCBT with 22 of those patients developing PES. Full-intensity myeloablative conditioning regimen was found to be a risk factor for development of PES. Of those 22 patients, 13 had resting hypoxemia. The most common radiographic findings included diffuse ground glass opacities with pleural effusions. Fifteen patients with PES received corticosteroids, of which 12 had improvement in fevers and rash. These patients had a trend toward worse mortality than those not receiving corticosteroids. There was a nonsignificant trend toward worse survival in patients with PES and hypoxemia compared to those without hypoxemia. PES is a common complication following cord blood transplantation, with hypoxemia being present in over half of patients with PES. Hypoxemia with PES and treatment with corticosteroids may portend a worse prognosis.
authors.affiliation: Division of Pulmonary and Critical Care Medicine, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 66160, USA, kbrownback@kumc.edu.
authors.forename: Kyle R
authors.initials: KR
authors.lastname: Brownback
authors.forename: Steven Q
authors.initials: SQ
authors.lastname: Simpson
authors.forename: Joseph P
authors.initials: JP
authors.lastname: McGuirk
authors.forename: Tara L
authors.initials: TL
authors.lastname: Lin
authors.forename: Sunil
authors.initials: S
authors.lastname: Abhyankar
authors.forename: Siddhartha
authors.initials: S
authors.lastname: Ganguly
authors.forename: Omar S
authors.initials: OS
authors.lastname: Aljitawi
mesh_terms: D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D036101:Cord Blood Stem Cell Transplantation / Q000009:adverse effects*; D005260:Female; D006085:Graft Survival; D006086:Graft vs Host Disease / Q000209:etiology / Q000401:mortality / Q000503:physiopathology* / Q000628:therapy; D019337:Hematologic Neoplasms / Q000401:mortality / Q000503:physiopathology* / Q000628:therapy; D006801:Humans; D000860:Hypoxia / Q000209:etiology / Q000401:mortality / Q000503:physiopathology* / Q000628:therapy; D008168:Lung / Q000187:drug effects / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D019653:Myeloablative Agonists / Q000627:therapeutic use; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis; D019172:Transplantation Conditioning; D016896:Treatment Outcome
chemical_list: D000305:Adrenal Cortex Hormones; D019653:Myeloablative Agonists