Engraftment Syndrome after Autologous Stem Cell Transplantation: An Update Unifying the Definition and Management Approach.
Engraftment syndrome (ES) encompasses a continuum of periengraftment complications after autologous hematopoietic stem cell transplantation. ES may include noninfectious fever, skin rash, diarrhea, hepatic dysfunction, renal dysfunction, transient encephalopathy, and capillary leak features, such as noncardiogenic pulmonary infiltrates, hypoxia, and weight gain with no alternative etiologic basis other than engraftment. Given its pleiotropic clinical presentation, the transplant field has struggled to clearly define ES and related syndromes. Here, we present a comprehensive review of ES in all documented disease settings. Furthermore, we discuss the proposed risk factors, etiology, and clinical relevance of ES. Finally, our current approach to ES is included along with a proposed treatment algorithm for the management of this complication.
Division of Hematology and Oncology, Department of Internal Medicine, Vanderbilt University Medical Center, Nashville, Tennessee. Electronic address: robert.f.cornell@vanderbilt.edu.
Robert Frank
RF
Cornell
Division of Hematology and Oncology, Department of Internal Medicine, The Medical College of Wisconsin, Milwaukee, Wisconsin.
Parameswaran
P
Hari
Division of Hematology and Oncology, Department of Internal Medicine, The Medical College of Wisconsin, Milwaukee, Wisconsin.
William R
WR
Drobyski
D001927:Brain Diseases / Q000209:etiology / Q000276:immunology / Q000473:pathology / Q000628:therapy; D019559:Capillary Leak Syndrome / Q000209:etiology / Q000276:immunology / Q000473:pathology / Q000628:therapy; D003967:Diarrhea / Q000209:etiology / Q000276:immunology / Q000473:pathology / Q000628:therapy; D005076:Exanthema / Q000209:etiology / Q000276:immunology / Q000473:pathology / Q000628:therapy; D005334:Fever / Q000209:etiology / Q000276:immunology / Q000473:pathology / Q000628:therapy; D006086:Graft vs Host Disease / Q000276:immunology / Q000473:pathology / Q000628:therapy*; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects / Q000379:methods*; D048550:Hepatic Insufficiency / Q000209:etiology / Q000276:immunology / Q000473:pathology / Q000628:therapy; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008223:Lymphoma / Q000276:immunology / Q000473:pathology / Q000628:therapy*; D009101:Multiple Myeloma / Q000276:immunology / Q000473:pathology / Q000628:therapy*; D016878:POEMS Syndrome / Q000276:immunology / Q000473:pathology / Q000628:therapy*; D051437:Renal Insufficiency / Q000209:etiology / Q000276:immunology / Q000473:pathology / Q000628:therapy; D012307:Risk Factors; D019172:Transplantation Conditioning; D014182:Transplantation, Autologous
D007166:Immunosuppressive Agents
Autologous graft-versus-host disease; Engraftment syndrome; Lymphoma; Multiple myeloma; POEMS