1.
Characteristics of Engraftment Syndrome Following Autologous Stem Cell Transplantation in Light Chain Amyloidosis with Renal Involvement
Miao, F., Ren, G., Guo, J., Zhao, L., Xu, W., Huang, X.
Transplantation and cellular therapy. 2022
Abstract
BACKGROUND Engraftment syndrome (ES) is a clinical complication that occurs during the neutrophil recovery phase following hematopoietic stem cell transplantation. The clinical features of ES in light chain (AL) amyloidosis remains to be thoroughly investigated. OBJECTIVE To better understand the characteristics of ES following autologous stem cell transplantation (ASCT) in AL amyloidosis with renal involvement. STUDY DESIGN We conducted this single-center retrospective study on 302 patients with AL amyloidosis who received ASCT between July 2010 and December 2021. RESULTS A total of 67/302 (22.2%) patients developed with ES, and the median time to occurrence of ES after stem cell reinfusion was 11 days (range, 7-17). Among the outcome measures in this study, estimated glomerular filtration rate (eGFR) at baseline and C-reactive protein (CRP) on the day of granulocyte engraftment were statistically different between ES and non-ES patients. We observed no significant difference between ES and non-ES patients in terms of transplant-related adverse events (Grade ≥ 2), hematologic and organ responses, overall survival, and progression-free survival. Furthermore, CRP at granulocyte engraftment [Odds Ratio (OR): 1.012, 95% confidence interval (CI): 1.004-1.020, P=0.002] and the absence of induction chemotherapy before ASCT (OR: 1.977, 95% CI: 1.047-3.731, P=0.036) were identified as risk factors for the development of ES. Whereas a higher eGFR at baseline (OR: 0.981, 95% CI: 0.969-0.993, P=0.002) was a factor that protects against ES. CONCLUSIONS We reported a 22.2% incidence of ES in AL amyloidosis patients with renal involvement after ASCT, and described its clinical features. Furthermore, associated risk and protective factors were identified, which increased the understanding of this clinical complication.
2.
Engraftment Syndrome and Acute Graft-versus-Host Disease: A Meta-Analysis
Poonsombudlert, K., Kewcharoen, J., Prueksapraopong, C., Limpruttidham, N.
Hawai'i journal of health & social welfare. 2020;79(6):194-201
Abstract
Engraftment syndrome (ES) has been associated with the surge of neutrophils and cytokines, which is similar to the presumed underlying pathophysiology behind acute graft-versus-host disease (aGVHD). However, there has been no meta-analysis to evaluate the association; therefore, the team attempted to verify an association between ES and aGVHD through meta-analysis. The team searched for titles of articles in MEDLINE (PubMed), the Cochrane Library, and the EMBASE database up until December 2018 that evaluated the association between ES and aGVHD and conducted a random effect meta-analysis of 8 studies involving a total of 1,945 participants to report the pooled odds ratio (OR) for association of ES and aGVHD. The team found a significantly increased odds of developing aGVHD in patients with ES with the pooled OR of 2.76 (95% confidence interval [CI]: 1.64-4.63) and an I(2) (=) 64.5%. In conclusion, patients with ES have significantly higher odds of developing aGVHD compared to patients without ES.
3.
Procalcitonin and cytokine profiles in engraftment syndrome in pediatric stem cell transplantation
Shah, N. N., Watson, T. M., Yates, B., Liewehr, D. J., Steinberg, S. M., Jacobsohn, D., Fry, T. J.
Pediatric Blood & Cancer. 2017;64(3)
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Abstract
BACKGROUND Diagnosis of engraftment syndrome (ES) following allogeneic hematopoietic stem cell transplantation (HSCT) can be a challenge due to the systemic presentation and alternative etiologies. With a goal of establishing biomarkers to more accurately distinguish ES, we prospectively analyzed levels of cytokines during HSCT. PROCEDURES We performed a prospective study of children <=21 years who underwent allogeneic HSCT. Blood samples for interleukin (IL)-6, IL-8, IL-10, IL-1b, IL-12p70, interferon-gamma, tumor necrosis factor alpha (TNF-alpha) and procalcitonin were obtained from each subject prior to conditioning, at day 0, and then biweekly through engraftment and at days 30, 60 and 100. Patients were evaluated for ES, infection and acute graft-versus-host disease. Cytokines were analyzed by values at engraftment, and also compared to pre-conditioning and day 0 values to evaluate for change from baseline. RESULTS A total of 30 subjects (median age: 7 years, min.-max.: 1-21 years) were enrolled of whom 5 had ES. Characterization of the cytokine profile revealed differences between day 0 from pre-HSCT, with a trend towards differences in IL-10, IL-12p70, interferon-gamma and TNF-alpha at the time of ES. For IL8 and procalcitonin, there was evidence that the absolute difference (or fold change) between engraftment and pre-conditioning or day 0 differed according to ES. In particular, procalcitonin increased from baseline (15.1 median fold increase in ES+ versus 2.31 median fold increase in ES-, P = 0.0006, median difference: 13.8, 95% confidence interval: 6.33, 65.6). CONCLUSIONS Our data provide one of the first prospective studies evaluating cytokines in pediatric allogeneic HSCT and suggest that elevated procalcitonin may serve as a biomarker for ES. Further studies to evaluate this finding are warranted.