title: Favorable outcome to glucocorticoid therapy for engraftment syndrome in pediatric autologous hematopoietic cell transplant.
abstract: ES remains an important cause of morbidity and mortality in children undergoing auto-HCT. Glucocorticoid use in ES is an area of debate. We retrospectively analyzed single-institution experience from September 2000 through December 2012 to evaluate the use of glucocorticoids in auto-HCT patients. ES was defined by the occurrence of new onset of non-infectious fever plus diarrhea, rash, or pulmonary infiltrates 24-h before or within five days after neutrophil engraftment. Sixty-five pediatric patients (<21 yr) with different solid tumors underwent auto-HCTs in the study period. Fifteen patients (23%) fulfilled criteria for ES, of which 13 received methylprednisolone (2 mg/kg IV for 3-5 days). Clinical improvement occurred in all patients within 48 h without significant complications. In the non-ES group, 11 patients received glucocorticoid without significant complications as well. MEL-based regimens were found to be significant factor for ES (p < 0.05). Fever, edema, non-infectious diarrhea, and serum albumin concentration were statistically different between the two groups. Median hospital length of stay was higher in the ES group.
  
  
  CONCLUSIONS
  ES is a common complication in children after auto-HCT and short-course glucocorticoid therapy is an effective and well-tolerated treatment, even in those who did not completely fulfill diagnostic criteria.
authors.affiliation: Division of Hematology/Oncology and Bone Marrow Transplantation, Stead Family Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, IA, USA.
authors.forename: Chenue
authors.initials: C
authors.lastname: Abongwa
authors.affiliation: Division of Hematology/Oncology and Bone Marrow Transplant, Department of Pediatrics, Nationwide Children's Hospital, Ohio State University, Columbus, OH, USA.
authors.forename: Rolla
authors.initials: R
authors.lastname: Abu-Arja
authors.affiliation: Division of Hematology/Oncology and Bone Marrow Transplantation, Stead Family Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, IA, USA.
authors.forename: Stephen
authors.initials: S
authors.lastname: Rumelhart
authors.affiliation: Seidman Cancer Center, Department of Medicine, University Hospitals Case Medical Center, Case Comprehensive Cancer Center, Cleveland, OH, USA.
authors.forename: Hillard M
authors.initials: HM
authors.lastname: Lazarus
authors.affiliation: Division of Hematology/Oncology and Bone Marrow Transplantation, Stead Family Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, IA, USA.
authors.forename: Ghada
authors.initials: G
authors.lastname: Abusin
mesh_terms: D000293:Adolescent; D000970:Antineoplastic Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use*; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D007902:Length of Stay; D008297:Male; D009369:Neoplasms / Q000628:therapy*; D012189:Retrospective Studies; D012307:Risk Factors; D013256:Steroids / Q000627:therapeutic use; D011795:Surveys and Questionnaires; D019172:Transplantation Conditioning / Q000379:methods; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents; D005938:Glucocorticoids; D013256:Steroids
keywords: engraftment syndrome; glucocorticoid; pediatric autologous hematopoietic cell transplant; pediatrics; peri-engraftment