Pre-Engraftment Syndrome after Unrelated Cord Blood Transplantation: A Predictor of Engraftment and Acute Graft-versus-Host Disease

Meerim Park; Soo Hyun Lee; Young Ho Lee; Keon Hee Yoo; Ki Woong Sung; Hong Hoe Koo; Hyoung Jin Kang; Kyung Duk Park; Hee Young Shin; Hyo Seop Ahn; Nak Gyun Chung; Bin Cho; Hack Ki Kim; Kyung Nam Koh; Ho Joon Im; Jong Jin Seo; Dong Kyun Han; Hee Jo Baek; Hoon Kook; Tai Ju Hwang; Eun Kyung Lee; Jeong Ok Hah; Yeon Jung Lim; Hyun Joo Jung; Jun Eun Park; Moon Ju Jang; So Young Chong; Doyeun Oh

doi:10.1016/j.bbmt.2013.01.014

Pre-Engraftment Syndrome after Unrelated Cord Blood Transplantation: A Predictor of Engraftment and Acute Graft-versus-Host Disease

Meerim Park, Soo Hyun Lee, Young Ho Lee, Keon Hee Yoo, Ki Woong Sung, Hong Hoe Koo, Hyoung Jin Kang, Kyung Duk Park, Hee Young Shin, Hyo Seop Ahn, Nak Gyun Chung, Bin Cho, Hack Ki Kim, Kyung Nam Koh, Ho Joon Im, Jong Jin Seo, Dong Kyun Han, Hee Jo Baek, Hoon Kook, Tai Ju HwangEun Kyung Lee, Jeong Ok Hah, Yeon Jung Lim, Hyun Joo Jung, Jun Eun Park, Moon Ju Jang, So Young Chong, Doyeun Oh

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Abstract

Pre-engraftment syndrome (PES) is poorly characterized, and its clinical significance and the prognostic impact after unrelated cord blood transplantation (CBT) are unclear. To address these issues, we retrospectively analyzed the incidence, risk factors, and clinical outcomes of PES in unrelated CBT recipients. Data of 381 patients who received unrelated CBT from 18 medical centers in Korea were reviewed. PES was defined as unexplained fever >38.3°C not associated with infection, and/or unexplained skin rash with or without evidence of fluid retention before neutrophil recovery. PES developed in 102 patients (26.8%) at a median of 7 days after CBT. Of these patients, 74 patients (72.5%) received intravenous corticosteroid at a median dose of 1 mg/kg/day, and of these, 95% showed clinical improvement. Risk factors for developing PES included low risk disease, myeloablative conditioning, graft-versus-host disease (GVHD) prophylaxis without methotrexate or corticosteroid, and >5.43 x 10⁷/kg infused nucleated cells. Absence of PES was one of the risk factors for graft failure in multivariate analysis. The cumulative incidence of grade II to grade IV acute GVHD by 100 days after CBT was higher in patients with PES than in those without PES (56.0% versus 34.4%, P < .01). PES was not associated with chronic GVHD, treatment-related mortality, relapse, or overall survival. PES seems to be common after CBT and may be associated with enhanced engraftment without significant morbidity.

Original language	English
Pages (from-to)	640-646
Number of pages	7
Journal	Biology of Blood and Marrow Transplantation
Volume	19
Issue number	4
DOIs	https://doi.org/10.1016/j.bbmt.2013.01.014
State	Published - Apr 2013

Bibliographical note

Funding Information:
This study was conducted at the following institutions: College of Medicine, Chungbuk National University, Cheongju; Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; Hanyang University Medical Center, Hanyang University College of Medicine, Seoul, Korea; Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea; Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea; Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Korea; Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Gwangju, Korea; Yeungnam University, Daegu; Chungnam National University, Daejon, Korea; Ajou University School of Medicine, Suwon, Korea; CHA Bundang Medical Center, CHA University, Seongnam; Mokdong Hospital, Ehwa Women's University, Seoul, Korea; Yonsei University, College of Medicine, Seoul, Korea; Gyeonsang National University School of Medicine, Jinju, Korea; Pusan National University, School of Medicine, Pusan; National Cancer Center, Goyang; Konkuk University College of Medicine, Seoul, Korea; Gachon University Gil Hospital, Gachon University School of Medicine, Incheon, Korea; and Daegu Fatima Hospital, Daegu, Korea.

Keywords

Cord blood transplantation
Outcome
Pre-engraftment syndrome
Risk factor

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10.1016/j.bbmt.2013.01.014

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Park, M., Lee, S. H., Lee, Y. H., Yoo, K. H., Sung, K. W., Koo, H. H., Kang, H. J., Park, K. D., Shin, H. Y., Ahn, H. S., Chung, N. G., Cho, B., Kim, H. K., Koh, K. N., Im, H. J., Seo, J. J., Han, D. K., Baek, H. J., Kook, H., ... Oh, D. (2013). Pre-Engraftment Syndrome after Unrelated Cord Blood Transplantation: A Predictor of Engraftment and Acute Graft-versus-Host Disease. Biology of Blood and Marrow Transplantation, 19(4), 640-646. https://doi.org/10.1016/j.bbmt.2013.01.014

@article{4ce3f2cf926d4f4da16107ef4677c2c7,

title = "Pre-Engraftment Syndrome after Unrelated Cord Blood Transplantation: A Predictor of Engraftment and Acute Graft-versus-Host Disease",

abstract = "Pre-engraftment syndrome (PES) is poorly characterized, and its clinical significance and the prognostic impact after unrelated cord blood transplantation (CBT) are unclear. To address these issues, we retrospectively analyzed the incidence, risk factors, and clinical outcomes of PES in unrelated CBT recipients. Data of 381 patients who received unrelated CBT from 18 medical centers in Korea were reviewed. PES was defined as unexplained fever >38.3°C not associated with infection, and/or unexplained skin rash with or without evidence of fluid retention before neutrophil recovery. PES developed in 102 patients (26.8%) at a median of 7 days after CBT. Of these patients, 74 patients (72.5%) received intravenous corticosteroid at a median dose of 1 mg/kg/day, and of these, 95% showed clinical improvement. Risk factors for developing PES included low risk disease, myeloablative conditioning, graft-versus-host disease (GVHD) prophylaxis without methotrexate or corticosteroid, and >5.43 x 107/kg infused nucleated cells. Absence of PES was one of the risk factors for graft failure in multivariate analysis. The cumulative incidence of grade II to grade IV acute GVHD by 100 days after CBT was higher in patients with PES than in those without PES (56.0% versus 34.4%, P < .01). PES was not associated with chronic GVHD, treatment-related mortality, relapse, or overall survival. PES seems to be common after CBT and may be associated with enhanced engraftment without significant morbidity.",

keywords = "Cord blood transplantation, Outcome, Pre-engraftment syndrome, Risk factor",

author = "Meerim Park and Lee, {Soo Hyun} and Lee, {Young Ho} and Yoo, {Keon Hee} and Sung, {Ki Woong} and Koo, {Hong Hoe} and Kang, {Hyoung Jin} and Park, {Kyung Duk} and Shin, {Hee Young} and Ahn, {Hyo Seop} and Chung, {Nak Gyun} and Bin Cho and Kim, {Hack Ki} and Koh, {Kyung Nam} and Im, {Ho Joon} and Seo, {Jong Jin} and Han, {Dong Kyun} and Baek, {Hee Jo} and Hoon Kook and Hwang, {Tai Ju} and Lee, {Eun Kyung} and Hah, {Jeong Ok} and Lim, {Yeon Jung} and Jung, {Hyun Joo} and Park, {Jun Eun} and Jang, {Moon Ju} and Chong, {So Young} and Doyeun Oh",

note = "Funding Information: This study was conducted at the following institutions: College of Medicine, Chungbuk National University, Cheongju; Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; Hanyang University Medical Center, Hanyang University College of Medicine, Seoul, Korea; Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea; Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea; Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Korea; Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Gwangju, Korea; Yeungnam University, Daegu; Chungnam National University, Daejon, Korea; Ajou University School of Medicine, Suwon, Korea; CHA Bundang Medical Center, CHA University, Seongnam; Mokdong Hospital, Ehwa Women's University, Seoul, Korea; Yonsei University, College of Medicine, Seoul, Korea; Gyeonsang National University School of Medicine, Jinju, Korea; Pusan National University, School of Medicine, Pusan; National Cancer Center, Goyang; Konkuk University College of Medicine, Seoul, Korea; Gachon University Gil Hospital, Gachon University School of Medicine, Incheon, Korea; and Daegu Fatima Hospital, Daegu, Korea. ",

year = "2013",

month = apr,

doi = "10.1016/j.bbmt.2013.01.014",

language = "English",

volume = "19",

pages = "640--646",

journal = "Biology of Blood and Marrow Transplantation",

issn = "1083-8791",

publisher = "Elsevier B.V.",

number = "4",

}

Park, M, Lee, SH, Lee, YH, Yoo, KH, Sung, KW, Koo, HH, Kang, HJ, Park, KD, Shin, HY, Ahn, HS, Chung, NG , Cho, B, Kim, HK, Koh, KN, Im, HJ, Seo, JJ, Han, DK, Baek, HJ, Kook, H, Hwang, TJ, Lee, EK, Hah, JO, Lim, YJ, Jung, HJ, Park, JE, Jang, MJ, Chong, SY & Oh, D 2013, 'Pre-Engraftment Syndrome after Unrelated Cord Blood Transplantation: A Predictor of Engraftment and Acute Graft-versus-Host Disease', Biology of Blood and Marrow Transplantation, vol. 19, no. 4, pp. 640-646. https://doi.org/10.1016/j.bbmt.2013.01.014

TY - JOUR

T1 - Pre-Engraftment Syndrome after Unrelated Cord Blood Transplantation

T2 - A Predictor of Engraftment and Acute Graft-versus-Host Disease

AU - Park, Meerim

AU - Lee, Soo Hyun

AU - Lee, Young Ho

AU - Yoo, Keon Hee

AU - Sung, Ki Woong

AU - Koo, Hong Hoe

AU - Kang, Hyoung Jin

AU - Park, Kyung Duk

AU - Shin, Hee Young

AU - Ahn, Hyo Seop

AU - Chung, Nak Gyun

AU - Cho, Bin

AU - Kim, Hack Ki

AU - Koh, Kyung Nam

AU - Im, Ho Joon

AU - Seo, Jong Jin

AU - Han, Dong Kyun

AU - Baek, Hee Jo

AU - Kook, Hoon

AU - Hwang, Tai Ju

AU - Lee, Eun Kyung

AU - Hah, Jeong Ok

AU - Lim, Yeon Jung

AU - Jung, Hyun Joo

AU - Park, Jun Eun

AU - Jang, Moon Ju

AU - Chong, So Young

AU - Oh, Doyeun

N1 - Funding Information: This study was conducted at the following institutions: College of Medicine, Chungbuk National University, Cheongju; Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; Hanyang University Medical Center, Hanyang University College of Medicine, Seoul, Korea; Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea; Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea; Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Korea; Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Gwangju, Korea; Yeungnam University, Daegu; Chungnam National University, Daejon, Korea; Ajou University School of Medicine, Suwon, Korea; CHA Bundang Medical Center, CHA University, Seongnam; Mokdong Hospital, Ehwa Women's University, Seoul, Korea; Yonsei University, College of Medicine, Seoul, Korea; Gyeonsang National University School of Medicine, Jinju, Korea; Pusan National University, School of Medicine, Pusan; National Cancer Center, Goyang; Konkuk University College of Medicine, Seoul, Korea; Gachon University Gil Hospital, Gachon University School of Medicine, Incheon, Korea; and Daegu Fatima Hospital, Daegu, Korea.

PY - 2013/4

Y1 - 2013/4

N2 - Pre-engraftment syndrome (PES) is poorly characterized, and its clinical significance and the prognostic impact after unrelated cord blood transplantation (CBT) are unclear. To address these issues, we retrospectively analyzed the incidence, risk factors, and clinical outcomes of PES in unrelated CBT recipients. Data of 381 patients who received unrelated CBT from 18 medical centers in Korea were reviewed. PES was defined as unexplained fever >38.3°C not associated with infection, and/or unexplained skin rash with or without evidence of fluid retention before neutrophil recovery. PES developed in 102 patients (26.8%) at a median of 7 days after CBT. Of these patients, 74 patients (72.5%) received intravenous corticosteroid at a median dose of 1 mg/kg/day, and of these, 95% showed clinical improvement. Risk factors for developing PES included low risk disease, myeloablative conditioning, graft-versus-host disease (GVHD) prophylaxis without methotrexate or corticosteroid, and >5.43 x 107/kg infused nucleated cells. Absence of PES was one of the risk factors for graft failure in multivariate analysis. The cumulative incidence of grade II to grade IV acute GVHD by 100 days after CBT was higher in patients with PES than in those without PES (56.0% versus 34.4%, P < .01). PES was not associated with chronic GVHD, treatment-related mortality, relapse, or overall survival. PES seems to be common after CBT and may be associated with enhanced engraftment without significant morbidity.

AB - Pre-engraftment syndrome (PES) is poorly characterized, and its clinical significance and the prognostic impact after unrelated cord blood transplantation (CBT) are unclear. To address these issues, we retrospectively analyzed the incidence, risk factors, and clinical outcomes of PES in unrelated CBT recipients. Data of 381 patients who received unrelated CBT from 18 medical centers in Korea were reviewed. PES was defined as unexplained fever >38.3°C not associated with infection, and/or unexplained skin rash with or without evidence of fluid retention before neutrophil recovery. PES developed in 102 patients (26.8%) at a median of 7 days after CBT. Of these patients, 74 patients (72.5%) received intravenous corticosteroid at a median dose of 1 mg/kg/day, and of these, 95% showed clinical improvement. Risk factors for developing PES included low risk disease, myeloablative conditioning, graft-versus-host disease (GVHD) prophylaxis without methotrexate or corticosteroid, and >5.43 x 107/kg infused nucleated cells. Absence of PES was one of the risk factors for graft failure in multivariate analysis. The cumulative incidence of grade II to grade IV acute GVHD by 100 days after CBT was higher in patients with PES than in those without PES (56.0% versus 34.4%, P < .01). PES was not associated with chronic GVHD, treatment-related mortality, relapse, or overall survival. PES seems to be common after CBT and may be associated with enhanced engraftment without significant morbidity.

KW - Cord blood transplantation

KW - Outcome

KW - Pre-engraftment syndrome

KW - Risk factor

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U2 - 10.1016/j.bbmt.2013.01.014

DO - 10.1016/j.bbmt.2013.01.014

M3 - Article

C2 - 23380345

AN - SCOPUS:84875525361

SN - 1083-8791

VL - 19

SP - 640

EP - 646

JO - Biology of Blood and Marrow Transplantation

JF - Biology of Blood and Marrow Transplantation

IS - 4

ER -

Pre-Engraftment Syndrome after Unrelated Cord Blood Transplantation: A Predictor of Engraftment and Acute Graft-versus-Host Disease

Abstract

Bibliographical note

Keywords

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