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Ikeda DJ, DeFilipp Z, Collier K, Chen YB, Dey BR, El-Jawahri A, Frigault MJ, Leick MB, McAfee SL, Newcomb RA, O'Donnell PV, Spitzer TR. Low incidence of engraftment syndrome following allogeneic hematopoietic cell transplantation with post-transplant cyclophosphamide. Bone Marrow Transplant 2024; 59:131-133. [PMID: 37821533 DOI: 10.1038/s41409-023-02123-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 09/19/2023] [Accepted: 10/04/2023] [Indexed: 10/13/2023]
Affiliation(s)
| | - Zachariah DeFilipp
- Harvard Medical School, Boston, MA, USA
- Hematopoietic Cell Transplant and Cellular Therapy Program, Massachusetts General Hospital, Boston, MA, USA
| | - Kerry Collier
- Harvard Medical School, Boston, MA, USA
- Hematopoietic Cell Transplant and Cellular Therapy Program, Massachusetts General Hospital, Boston, MA, USA
| | - Yi-Bin Chen
- Harvard Medical School, Boston, MA, USA
- Hematopoietic Cell Transplant and Cellular Therapy Program, Massachusetts General Hospital, Boston, MA, USA
| | - Bimalangshu R Dey
- Harvard Medical School, Boston, MA, USA
- Hematopoietic Cell Transplant and Cellular Therapy Program, Massachusetts General Hospital, Boston, MA, USA
| | - Areej El-Jawahri
- Harvard Medical School, Boston, MA, USA
- Hematopoietic Cell Transplant and Cellular Therapy Program, Massachusetts General Hospital, Boston, MA, USA
| | - Matthew J Frigault
- Harvard Medical School, Boston, MA, USA
- Hematopoietic Cell Transplant and Cellular Therapy Program, Massachusetts General Hospital, Boston, MA, USA
| | - Mark B Leick
- Harvard Medical School, Boston, MA, USA
- Hematopoietic Cell Transplant and Cellular Therapy Program, Massachusetts General Hospital, Boston, MA, USA
| | - Steven L McAfee
- Harvard Medical School, Boston, MA, USA
- Hematopoietic Cell Transplant and Cellular Therapy Program, Massachusetts General Hospital, Boston, MA, USA
| | - Richard A Newcomb
- Harvard Medical School, Boston, MA, USA
- Hematopoietic Cell Transplant and Cellular Therapy Program, Massachusetts General Hospital, Boston, MA, USA
| | - Paul V O'Donnell
- Harvard Medical School, Boston, MA, USA
- Hematopoietic Cell Transplant and Cellular Therapy Program, Massachusetts General Hospital, Boston, MA, USA
| | - Thomas R Spitzer
- Harvard Medical School, Boston, MA, USA.
- Hematopoietic Cell Transplant and Cellular Therapy Program, Massachusetts General Hospital, Boston, MA, USA.
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2
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ElGohary G, Toor AA, Gergis U. Engraftment syndrome after allogeneic stem cell transplantation: a systematic review and meta-analysis. Bone Marrow Transplant 2023; 58:1-9. [PMID: 36284212 DOI: 10.1038/s41409-022-01849-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 10/04/2022] [Accepted: 10/07/2022] [Indexed: 01/07/2023]
Abstract
Engraftment syndrome (ES) is associated with neutrophil recovery after stem cell transplantation (SCT). It is associated with autologous and allogeneic SCT. However, a literature review has shown that allogeneic SCT (allo-SCT) is associated with ES without conclusive data on risk factors or effects on outcomes. This meta-analysis was undertaken to estimate the cumulative incidence of ES following allo-SCT, and to evaluate the risk factors and outcomes among patients with ES following allo-SCT. Current literature was searched using electronic databases, and manually. Studies with ES after allo-SCT were selected, and a meta-analysis of proportion was performed using the Freeman-Tukey Double Arcsine transformation, random-effects model to calculate the cumulative incidence of ES. Donor type, source of haematopoetic stem cells, graft vs. host disease (GvHD) prophylaxes, and conditioning regimens' intensity were evaluated for risk factors for ES. Association of acute GvHD (aGvHD), chronic GvHD (cGvHD), relapse, nonrelapse mortality (NRM), and overall survival (OS) between the ES and no ES groups were assessed using the odds ratio (OR). Eighteen studies were included comprising 3620 patients receiving allo-SCT and 774 of them had developed ES with a cumulative incidence of 35.4%. The odds of aGvHD (OR 2.5, p < 0.001), cGvHD (OR 4.5, p = 0.021), and NRM (OR 1.8, p = 0.01) were higher among patients who developed ES. The odds of relapse were significantly less (OR = 0.679, p = 0.011) among the ES group. OS (OR = 0.72, p < 0.001) was reduced in the ES group. Myeloablative conditioning was found to be a significant risk factor for ES development. In conclusion, ES after allo-SCT is common with higher odds of developing aGvHD, cGvHD, and NRM and lower odds of OS.
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Affiliation(s)
- Ghada ElGohary
- King Khalid University Hospital, Riyadh, Saudi Arabia. .,Faculty of Medicine, Ain Shams University, Cairo, Egypt.
| | - Amir A Toor
- Massey Cancer Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Usama Gergis
- Department of Medical Oncology, Division of Hematological Malignancies, Thomas Jefferson University Hospital, Philadelphia, PA, USA
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3
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Aydogdu S, Toret E, Aksoy BA, Aydın MF, Cipe FE, Bozkurt C, Fisgin T. Comparison of Hematopoietic Stem Cell Transplantation Results in Patients with β-Thalassemia Major from Three Different Graft Types. Hemoglobin 2021; 45:25-29. [PMID: 33478286 DOI: 10.1080/03630269.2021.1872611] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Allogeneic hematopoietic stem cell transplantation (HSCT) is the curative therapy for β-thalassemias that induces severe life-threatening complications. The human leukocyte antigen (HLA) registries and umbilical cord blood banks have carried out diligent searches to find matched unrelated donors (MUDs) for about 70.0% of patients from 2000 onwards. The chance of finding a non-sibling fully matched family donors is higher in some ethnic groups in which consanguineous marriages are common. We have studied and compared transplant complications and outcomes in different graft types (sibling, non-sibling family and unrelated). The non-sibling matched family donor (MFD) group consisted of four mothers, three fathers, five cousins, one paternal uncle and one paternal aunt. There was no significant difference in the mean transfused CD34+ cells, engraftment, median days of neutrophil and platelet recovery were achieved (p > 0.05). The distribution of postttransplant complication did not show any significant difference between groups (p > 0.05). In univariate analysis and multivarite analyses, age, gender, Pesaro risk group (I-II vs. III) and ABO incompatibilty demonstrated a significant difference in disease free survival (p < 0.05). Furthermore, in the second step of investigating overall survival (OS), age, gender and Pesaro risk group (I-II vs. III) showed a significant difference (p < 0.05). There was no significant difference in transplant-related mortality (TRM) between groups. Non-sibling related donor transplants are important for populations where consanguineous marriages are common. Transplant groups according to graft type had similar thalassemia-free survival (TFS) and OS when using a treosulfan-based regimen in our study.
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Affiliation(s)
- Selime Aydogdu
- Department of Pediatrics, Faculty of Medicine, Pediatric Bone Marrow Transplantation Unit, Bahcelievler Medical Park Hospital, Altinbas University, Istanbul, Turkey
| | - Ersin Toret
- Department of Pediatrics, Faculty of Medicine, Pediatric Bone Marrow Transplantation Unit, Bahcelievler Medical Park Hospital, Altinbas University, Istanbul, Turkey
| | - Basak A Aksoy
- Department of Pediatrics, Faculty of Medicine, Pediatric Bone Marrow Transplantation Unit, Bahcelievler Medical Park Hospital, Altinbas University, Istanbul, Turkey.,Department of Pediatrics, Faculty of Medicine, Istinye University, Istanbul, Turkey
| | - Muhammed Fatih Aydın
- Department of Pediatrics, Faculty of Medicine, Pediatric Bone Marrow Transplantation Unit, Bahcelievler Medical Park Hospital, Altinbas University, Istanbul, Turkey
| | - Funda E Cipe
- Department of Pediatrics, Faculty of Medicine, Pediatric Bone Marrow Transplantation Unit, Bahcelievler Medical Park Hospital, Altinbas University, Istanbul, Turkey
| | - Ceyhun Bozkurt
- Department of Pediatrics, Faculty of Medicine, Pediatric Bone Marrow Transplantation Unit, Bahcelievler Medical Park Hospital, Altinbas University, Istanbul, Turkey.,Department of Pediatrics, Faculty of Medicine, Istinye University, Istanbul, Turkey
| | - Tunc Fisgin
- Department of Pediatrics, Faculty of Medicine, Pediatric Bone Marrow Transplantation Unit, Bahcelievler Medical Park Hospital, Altinbas University, Istanbul, Turkey
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Elbahlawan L, Morrison R, Li Y, Huang S, Cheng C, Avent Y, Madden R. Outcome of Acute Respiratory Failure Secondary to Engraftment in Children After Hematopoietic Stem Cell Transplant. Front Oncol 2020; 10:584269. [PMID: 33163412 PMCID: PMC7581677 DOI: 10.3389/fonc.2020.584269] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 09/10/2020] [Indexed: 12/18/2022] Open
Abstract
Introduction: Respiratory complications due to engraftment syndrome (ES) in the post-hematopoietic stem cell transplant (HSCT) setting can lead to acute respiratory failure (ARF). Outcomes of children developing ARF due to engraftment are unknown. Methods: We conducted a retrospective analysis of 1,527 pediatric HSCT recipients and identified children who developed ARF due to ES over a 17-year period. Thirty patients that developed ARF and required invasive mechanical ventilation (IMV) due to ES were included in this study. Results: The survival rate for our cohort was 80% [alive at intensive care unit (ICU) discharge]. The most common underlying primary disease was hematologic malignancy, and 67% of children underwent allogeneic HSCT. Further, 73% required vasopressor drips and 23% underwent dialysis. Survivors had a shorter median ICU length of stay than did non-survivors (15 vs. 40 days, respectively, p = 0.01). Survivors had a significantly lower median cumulative fluid overload % on days 4 and 5 after initiation of IMV than did non-survivors (2.8 vs. 14.0 ml/kg, p = 0.038 on day 4, and 1.8 vs. 14.9 ml/kg, p = 0.044 on day 5, respectively). Conclusion: Our results suggest that children who develop ARF during engraftment have better ICU survival rates than do those with other etiologies of ARF post-HSCT. Furthermore, fluid overload contributes to mortality in these children; therefore, strategies to prevent and address fluid overload should be considered.
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Affiliation(s)
- Lama Elbahlawan
- Division of Critical Care Medicine, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Ray Morrison
- Division of Critical Care Medicine, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Ying Li
- Department of Bone Marrow Transplantation and Cellular Therapy, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Sujuan Huang
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Cheng Cheng
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Yvonne Avent
- Division of Critical Care Medicine, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Renee Madden
- Department of Bone Marrow Transplantation and Cellular Therapy, St. Jude Children's Research Hospital, Memphis, TN, United States
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Allogeneic reactivity-mediated endothelial cell complications after HSCT: a plea for consensual definitions. Blood Adv 2020; 3:2424-2435. [PMID: 31409584 DOI: 10.1182/bloodadvances.2019000143] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 07/02/2019] [Indexed: 12/21/2022] Open
Abstract
Endothelial cell (EC) activation has been suspected of triggering a group of rare and dismal complications that can occur after allogeneic hematopoietic stem cell transplantation (HSCT). Capillary leak syndrome, engraftment syndrome, transplant-associated microangiopathy, diffuse alveolar hemorrhage, and idiopathic pneumonia syndrome are the main nosological entities. Post-HSCT endotheliitis can be triggered by chemotherapy, infections, and calcineurin inhibitors, but allogeneic reactivity is claimed to be the common denominator. Endothelial damages are thought to activate several deleterious pathways (proapoptotic, procoagulant, proinflammatory) and can lead to multiorgan failure; however, clinical manifestations of each syndrome overlap, and their relationship with graft-versus-host disease could be minimal. The lack of well-defined diagnostic criteria does not allow for a clear-cut comparison in the current literature. Therapeutic efforts have been made to intercept the pathogenic mechanisms leading to EC dysfunction, but remission rates and survival remain mostly unsatisfactory. In this article, we have reviewed the incidence, clinical features, and treatment approaches of EC activation syndromes, and we plead for the development of internationally accepted standard definitions.
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Grant A, Chapman LR, Mitchell R, O’Brien TA. Engraftment syndrome following hematopoietic stem cell transplant: A review of the literature. Clin Transplant 2020; 34:e13875. [DOI: 10.1111/ctr.13875] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 03/31/2020] [Accepted: 04/02/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Andrew Grant
- Kids Cancer Centre Sydney Children’s Hospital Sydney Children’s Hospitals Network Randwick NSW Australia
| | - Laura R.M. Chapman
- Kids Cancer Centre Sydney Children’s Hospital Sydney Children’s Hospitals Network Randwick NSW Australia
| | - Richard Mitchell
- Kids Cancer Centre Sydney Children’s Hospital Sydney Children’s Hospitals Network Randwick NSW Australia
| | - Tracey A. O’Brien
- Kids Cancer Centre Sydney Children’s Hospital Sydney Children’s Hospitals Network Randwick NSW Australia
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7
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Dermatologic Conditions of the Early Post-Transplant Period in Hematopoietic Stem Cell Transplant Recipients. Am J Clin Dermatol 2019; 20:55-73. [PMID: 30298481 DOI: 10.1007/s40257-018-0391-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Hematopoietic stem cell transplants (HSCTs) are used to treat a variety of conditions, including hematologic malignancies, bone marrow failure syndromes, and immunodeficiencies. Over 60,000 HSCTs are performed annually worldwide, and the numbers continue to increase. Indeed, as new conditioning regimens develop, more and more individuals, including those of older age, will be eligible for transplants. Nevertheless, although HSCTs are clearly a life-saving and necessary treatment for thousands of patients per year, there is still substantial morbidity and mortality associated with the procedure. Of note, skin eruptions in the post-HSCT period are frequent and often significantly reduce quality of life in recipients. Moreover, these cutaneous findings sometimes herald an underlying systemic condition, presenting possible opportunities for timelier intervention. Dermatologists therefore play a vital role in distinguishing life-threatening conditions from benign issues and prompting recognition of critical complications earlier in their course. This article aims to review the major dermatologic conditions occurring in the early post-HSCT period.
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Potratz J, Ahlmann M, Rössig C, Omran H, Masjosthusmann K. Successful Extracorporeal Life Support in a Pediatric Hematopoietic Stem Cell Transplant Recipient With Periengraftment Respiratory Failure. J Pediatr Hematol Oncol 2018; 40:e256-e259. [PMID: 28816799 DOI: 10.1097/mph.0000000000000929] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The use of extracorporeal life support (ECLS) as ultimate salvage therapy for hematopoietic stem cell transplant recipients remains controversial among oncologists and critical care specialists. Prognosis is poor, particularly after allogeneic transplantation, and literature to guide clinical decision-making is scarce. Our report describes successful ECLS in a pediatric patient undergoing allogeneic hematopoietic stem cell transplantation, who developed acute respiratory failure during severe neutropenia, followed by immediate neutrophil engraftment. This unique case highlights periengraftment respiratory failure as a possible patient subgroup that could benefit from ECLS; and illustrates that the distinct etiologies of respiratory failure and the patients' immune status deserve closer consideration in future studies evaluating ECLS in this high-risk population.
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Affiliation(s)
- Jenny Potratz
- Departments of General Pediatrics-Intensive Care Medicine
| | - Martina Ahlmann
- Pediatric Hematology and Oncology, University Children's Hospital Münster, Münster, Germany
| | - Claudia Rössig
- Pediatric Hematology and Oncology, University Children's Hospital Münster, Münster, Germany
| | - Heymut Omran
- Departments of General Pediatrics-Intensive Care Medicine
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