1.
Incidence and characteristics of engraftment syndrome after autologous hematopoietic cell transplantation in light chain amyloidosis
Badar, T., Khan, M. A., Szabo, A., Drobyski, W., Chhabra, S., Dhakal, B., Fenske, T. S., Hamadani, M., Hari, P., Jerkins, J. H., et al
Amyloid : the international journal of experimental and clinical investigation : the official journal of the International Society of Amyloidosis. 2019;:1-6
Abstract
Engraftment syndrome (ES), a complication of autologous hematopoietic cell transplantation (auto-HCT), can occur around the time of neutrophil recovery. We sought to identify the incidence of ES in light chain (AL) amyloidosis patients undergoing auto-HCT at our centre by evaluating 72 consecutive amyloidosis patients transplanted between 1999 and 2017. To assess trends in ES over time, patients were divided into two Eras (Era 1 = 1999-2008 and Era 2 = 2009-2017) based on year of auto-HCT. Twenty-two (31%) patients developed ES; three (16%) and 19 (36%) in Era 1 and 2, respectively (p = .1). Three (16%) and 51 (96%) patients in Era 1 and 2 received chemotherapy before auto-HCT (p = <.001). The most common symptoms observed with ES in addition to fever was diarrhoea (73%), rash (68%), weight gain (56%) and non-cardiogenic pulmonary oedema (23%). Day 100 post-auto-HCT haematological response (19.5% vs. 14%, p = .7) or post-transplant best organ response (23% vs. 36%, p = .2) were not significantly different in patients who did not or did develop ES, respectively. In this single centre series, we define the incidence and characteristics of ES in AL amyloidosis patients undergoing auto-HCT.
2.
Peripheral Blood Grafts for T-Cell Replete Haploidentical Transplantation Increase the Incidence and Severity of Cytokine Release Syndrome
Raj, R. V., Hamadani, M., Szabo, A., Pasquini, M. C., Shah, N. N., Drobyski, W. R., Shaw, B. E., Saber, W., Rizzo, J. D., Jerkins, J., et al
Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation. 2018
Abstract
T-cell replete post-transplant cyclophosphamide (PT-CY)-based protocols have led to increasing use of haploidentical allogeneic hematopoietic cell transplantation (haploHCT). With this approach, bidirectional alloreactivity causing non-engraftment or severe graft-versus-host disease (GVHD) are no longer major barriers to haploHCT. PT-CY eliminates alloreactive lymphocytes but spares CD34+ stem cells and regulatory T lymphocytes, resulting in reliable hematopoietic recovery with relatively low incidence of GVHD. The immediate post-haploHCT course, usually before PT-CY administration, is often complicated by cytokine release syndrome (CRS). The predictors of CRS and its effect on outcomes post-transplant have not been fully ascertained. We analyzed the outcomes of 66 patients who received haploHCT at our institution. Using published CRS criteria, we identified 48 patients who developed CRS. In multivariate analysis, peripheral blood grafts were significantly associated with grade ≥2 CRS, compared to bone marrow. Grade ≥2 CRS (compared to grade <2) was not associated with differences in overall survival or non-relapse mortality. Severe CRS was associated with a statistically non-significant trend toward higher incidence of grade III-IV acute GVHD, especially in the context of peripheral blood grafts. CRS is a common complication after T-cell replete peripheral blood haploHCT, but post-transplant survival outcomes may not be affected in those with severe CRS.