Pre-engraftment Syndrome in Allogeneic Hematopoietic Stem Cell Transplantation / 대한소아혈액종양학회지

ABSTRACT

PURPOSE: Characteristic clinical findings of fever, skin rash with or without the evidence of fluid retention, mimicking engraftment syndrome (ES), have been observed during the pre-engraftment period in patients with hematopoietic stem cell transplantation (HSCT). We described these findings as pre-engraftment syndrome (pES) and analyzed the incidence and risk factors of pES in the pediatric patients who received HSCT with various stem cell sources. METHODS: Among 53 patients who received HSCT at Dong-A University Medical Center from Sep. 1997 to Mar. 2004, 37 patients with allogeneic HSCT were analyzed retrospectively to characterize the clinical syndrome. RESULTS: In 3 (21.4%) out of 14 patients with cord blood stem cell transplantation, non-infectious fever, skin rash and tachypnea developed on 4~15 days prior to neutrophil engraftment. Two of them spontaneously recovered just with fluid restriction and oxygen inhalation, however, one patient died of complicated pulmonary hemorrhage in spite of aggressive supportive therapy and steroid treatment. In 4 (17.4%) out of 23 patients with allogeneic bone marrow transplantation (BMT), non-infectious fever and skin rash developed on 4~5 days prior to neutrophil engraftment. All of them recovered with steroid treatment only. We could not find any risk factors for this syndrome, however, the speed of neutrophil engraftment was significantly faster in the patients with pES. CONCLUSION: We established a distinctive clinical syndrome during pre-engraftment period, which is very similar but different in occurrence timing from ES. The pES may be associated with enhanced engraftment, but has no impact on the other clinical outcomes.