title: Engraftment syndrome after allogeneic hematopoietic cell transplantation in adults.
abstract: We performed a retrospective study of the engraftment syndrome (ES) as defined by the Spitzer Criteria in adult patients undergoing allogeneic hematopoietic cell transplantation (HCT) for various hematological malignancies at a single institution, over a decade, and analyzed its relationship to acute GVHD; 217 patients underwent either myeloablative (38.7%) or reduced intensity (61.3%) HCT; 22.1% met the criteria for ES. Acute GVHD prophylaxis (P = 0.006) and transplants prior to 2006 (P < 0.0001) were significantly associated with a risk of ES in univariable analysis. Early aGVHD within 4 weeks of engraftment was significantly more common in the ES compared to the non ES cohort (21 vs. 8.3% respectively, P = 0.02). ES did not predict for future GVHD, as at day +180, the cumulative incidences of grades II-IV aGVHD (31 vs. 23%, P = 0.19) and of chronic GVHD at 2 years of engraftment (42 vs. 36%, P = 0.28) were not significantly different between the ES and non ES groups, respectively. No significant differences in NRM, overall survival and progression-free survival were observed between the two groups. Although predictive of early aGVHD, ES occurred independently of GVHD in 79% of the patients. Survival outcomes should be evaluated in a larger randomized study to investigate if there is a correlation with ES.
authors.affiliation: Division of Hematology, Oncology and Transplantation, University of Minnesota, Minneapolis, Minnesota; Department of Medicine, University of Minnesota, Minneapolis, Minnesota.
authors.forename: Aazim K
authors.initials: AK
authors.lastname: Omer
authors.forename: Haesook T
authors.initials: HT
authors.lastname: Kim
authors.forename: Bhargavi
authors.initials: B
authors.lastname: Yalamarti
authors.forename: Steven L
authors.initials: SL
authors.lastname: McAfee
authors.forename: Bimalangshu R
authors.initials: BR
authors.lastname: Dey
authors.forename: Karen K
authors.initials: KK
authors.lastname: Ballen
authors.forename: Eyal
authors.initials: E
authors.lastname: Attar
authors.forename: Yi-Bin
authors.initials: YB
authors.lastname: Chen
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Spitzer
mesh_terms: D000328:Adult; D000368:Aged; D003873:Dermatitis, Exfoliative / Q000209:etiology; D005260:Female; D005334:Fever / Q000209:etiology; D006085:Graft Survival / Q000502:physiology; D019337:Hematologic Neoplasms / Q000601:surgery; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D011654:Pulmonary Edema / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors; D013577:Syndrome; D019172:Transplantation Conditioning / Q000009:adverse effects / Q000379:methods; D014182:Transplantation, Autologous; D055815:Young Adult