Incidence, predisposing factors, and outcome of engraftment syndrome in pediatric allogeneic stem cell transplant recipients
Incidence, predisposing factors, and outcome of engraftment syndrome in pediatric allogeneic stem cell transplant recipients
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DOI：
10.1016/j.bbmt.2008.02.002
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发表时间：
2008-04-01
影响因子：
4.3
通讯作者：
Albert, Michael H.
中科院分区：
文献类型：
--
作者：
Schmid, Irene;Stachel, Daniel;Albert, Michael H.
移植物植入综合征（ES）是造血干细胞移植（HSCT）后中性粒细胞恢复过程中的一种炎症性疾病，以非感染性发热和皮疹为特征。据报道，它经常发生在儿童和成人自体HSCT后，并已被证明是增加移植相关死亡率（TRM）的独立风险因素。然而，几乎没有关于儿童异基因HSCT后其发生率的数据。为了确定儿童移植队列中ES的发生率、诱发因素和并发症，我们分析了61例连续接受清髓性异基因HSCT的受者ES的发生情况。当儿童在植入前7天内出现以下症状中的≥ 2种时，诊断为ES：（1）发热> 38.0 ℃，（2）皮疹，（3）体重增加和白蛋白下降，或（4）呼吸困难、缺氧和肺浸润。该队列中ES的发生率为48%（29/61）。在单变量分析中，移植后粒细胞集落刺激因子（G-CSF）给药（P = .02）和高单核细胞计数（MNC）（P = .002）被确定为诱发ES发生的重要风险因素。在多因素logistic回归分析中，阿替霉素B治疗（P = 0.009）和高MNC（P = 0.004）是ES风险的重要解释变量。ES患者慢性GVHD（cGVHD）发生率有升高的趋势（P = 0. 05）。11）。然而，在中位随访9.5年后，两组的总生存率（OS）（P = .53）和TRM（P = .65）没有差异。ES表现为发热、皮疹、体重增加和肺部症状，应被认为是儿童清髓性预处理后异基因HSCT的常见并发症。在本研究中，用G-CSF、阿替霉素B和移植物的高有核细胞计数处理易发生ES。该队列的OS和TRM不受ES发生的影响。(c)2008年美国血液和骨髓移植协会。
Engraftment syndrome (ES) has been recognized as an inflammatory condition during neutrophil recovery after hematopoietic stem cell transplantation (HSCT) characterized by noninfectious fever and skin rash. It has been reported to occur frequently after autologous HSCT in children and adults, and has been shown to be an independent risk factor for increased transplant-related mortality (TRM). However, virtually no data exist on its occurrence after allogeneic HSCT in children. To determine incidence, predisposing factors for, and complications of ES in a pediatric transplant cohort, we analyzed 61 consecutive recipients of a myeloablative allogeneic HSCT for the occurrence of ES. Diagnosis of ES was established when children presented with >= 2 of the following symptoms within 7 days before engraftment: (1) fever > 38.0 degrees C, (2) skin rash, (3) weight gain and albumin drop, or (4) dyspnea, hypoxia, and pulmonary infiltrates. Incidence of ES in this cohort was 48% (29 of 61). In a univariate analysis, posttransplant granulocyte-colony stimulating factor (G-CSF) administration (P = .02), and high mononuclear cell count (MNC) (P = .002) were identified as significant risk factors predisposing for the development of ES. In a multiple logistic regression analysis, amphotericin B therapy (P = .009) and high MNC (P = .004) were significant explanatory variables for ES risk. There was a slight trend toward a higher rate of chronic GVHD (cGVHD) in patients with ES (P =. 11). However, after a median follow-up of 9.5 years overall survival (OS) (P = .53) and TRM (P = .65) did not differ between the 2 groups. ES presenting with fever, rash, weight gain, and pulmonary symptoms should be recognized as a frequent complication of allogeneic HSCT after myeloablative conditioning in children. Treatment with G-CSF, amphotericin B, and a high nucleated cell count of the graft predisposed for the development of ES in this study. OS and TRM in this cohort were not affected by the occurrence of ES. (c) 2008 American Society for Blood and Marrow Transplantation.