Previous exposure to bortezomib is linked to a lower risk of engraftment syndrome after autologous hematopoietic stem cell transplantation

Plerixafor-based mobilization and mononuclear cell counts in graft increased the risk of engraftment syndrome after autologous hematopoietic stem cell transplantation

Engraftment syndrome (ES) is one of the most common complications in the early phase after autologous hematopoietic stem cell transplantation (ASCT), and we aimed to evaluate the incidence and risk factors for ES patients receiving ASCT in the era of plerixafor-based mobilization. A total of 294 were enrolled, and 16.0% (n = 47) experienced ES after ASCT. The main clinical manifestations were fever (100%), diarrhea (78.7%), skin rash (23.4%), and hypoxemia/pulmonary edema (12.8%). Plerixafor-based mobilization was associated with higher counts of CD3+ cells, CD4+ cells, and CD8+ cells in grafts. In univariate analysis of the total cohort, age ≥60 years, receiving ASCT at complete remission (CR), higher number of mononuclear cell (MNC), CD3+ cell counts, CD4+ cells as well as CD8+ cells transfused and plerixafor-based mobilization were associated with ES after ASCT. Multivariate analysis showed that age ≥60 years (P = .0014), receiving ASCT at CR (P = .002), and higher number of MNC transfused (P = .026) were associated with ES in total cohort. In plasma cell disease subgroup, age ≥60 years (P = .013), plerixafor-based mobilization (P = .036), and receiving ASCT at CR (P = .002) were associated with ES. Patients with more risk factors had a higher risk of ES. The 1-year probabilities of relapse, non-relapse mortality, and survival were comparable between patients with and without ES. Thus, plerixafor-based mobilization may influence the composition of T lymphocytes in grafts and increase the risk of ES, particularly in patients with plasma cell disease.

Characteristics of Engraftment Syndrome following Autologous Stem Cell Transplantation in Light Chain Amyloidosis with Renal Involvement

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. This study was conducted to better understand the characteristics of ES following autologous stem cell transplantation (ASCT) in AL amyloidosis with renal involvement. We conducted this single-center retrospective study in 302 patients with AL amyloidosis who underwent ASCT between July 2010 and December 2021. Sixty-seven of the 302 patients (22.2%) developed ES, with a median time to the occurrence of ES after stem cell reinfusion of 11 days (range, 7 to 17 days). Among the outcome measures in this study, estimated glomerular filtration rate (eGFR) at baseline and C-reactive protein (CRP) level on the day of granulocyte engraftment were statistically different between the ES patients and non-ES patients. We observed no significant difference between the 2 groups in transplantation-related adverse events (grade ≥ 2), hematologic and organ responses, overall survival, and progression-free survival. Furthermore, CRP level at granulocyte engraftment (odds ratio [OR], 1.012; 95% confidence interval [CI], 1.004 to 1.020; P = .002) and the absence of induction chemotherapy before ASCT (OR, 1.977; 95% CI, 1.047 to 3.731; P = .036) were identified as risk factors for the development of ES, whereas a higher eGFR at baseline (OR, .981; 95% CI, .969 to .993; P = .002) was identified as a protective factor against ES. Our data show a 22.2% incidence of ES in AL amyloidosis patients with renal involvement after ASCT and identify associated risk and protective factors, which can improve the understanding of this clinical complication.

Autologous Stem Cell Transplantation for Multiple Myeloma: Growth Factor Matters

Engraftment syndrome (ES) is a known complication of autologous hematopoietic stem cell transplant during neutrophil recovery. There is a limited amount of data available comparing the incidence of ES with post-transplant granulocyte colony-stimulating factor versus granulocyte macrophage colony-stimulating factor (GM-CSF), specifically in patients with multiple myeloma. Our retrospective review of 156 patients at a single center showed that GM-CSF was associated with a higher incidence of ES compared with G-CSF (32% versus 8% of patients, P < .001) and that development of ES was associated with a 32.9% (P < .001) longer hospital stay. This suggests that the choice of growth factor could possibly contribute to the development of ES and the associated costs of increased medical care.