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Engraftment syndrome after autologous peripheral blood stem cell transplantation with high numbers of peripheral blood stem cells followed by granulocyte colony-stimulating factor administration

Bone Marrow Transplantation volume 25, pages 228–229 (2000)Cite this article

Autologous peripheral blood stem cell transplantation (PBSCT) is characterized by rapid hematological recovery. Clinical studies have shown a direct relationship between the numbers of colony-forming unit granulocyte–macrophage (CFU-GM) or CD34+ cells in leukapheresis products and leukocyte recovery.1 The numbers of 1 to 2 × 105/kg CFU-GM or 1 to 2 × 106 CD34+ cells/kg are generally agreed as the minimum threshold for adequate hemato- poietic reconstitution.1 Although there seems to be an upper threshold at 5 × 105 CFU-GM/kg or 5 × 106 CD34+ cells/kg,1 patients receiving autologous PBSCT with a CD34+ cell dose ⩾5 × 106/kg have a reduced demand for red cell and platelet transfusions, a reduction in the use of antibiotics, and short periods of hospitalization.2 However, adverse effects of the infusion of high numbers of peripheral blood stem cells followed by granulocyte colony- stimulating factor (G-CSF) administration have not been well examined. We wish to report a patient with engraftment syndrome caused by autologous PBSCT followed by G-CSF treatment.

Complications such as non-infectious fever, skin rashes, fluid retention and pulmonary interstitial infiltrates associated with a rapid increase in neutrophil recovery after autologous blood stem cell transplantation are known as engraftment syndrome.34 The syndrome is closely associated with G-CSF administration after autologous blood stem cell transplantation.45 Pneumonitis is radiologically characterized by pulmonary interstitial infiltrates. G-CSF causes pneumonitis in patients who receive chemotherapy plus G-CSF.6 The mechanism of G-CSF-induced pneumonitis remains to be clarified. Chemotherapy plus G-CSF but not G-CSF alone causes pneumonitis in patients.6 G-CSF activates neutrophil functions7 and induces interleukin-6 production from neutrophils.8 These observations suggest that activated neutrophils induced by G-CSF exert deleterious effects on subclinical lung damage produced by anti-cancer agents. Our patient was heavily treated before receiving pretransplant conditioning and she received a lung-toxic agent, busulfan, as pretransplant conditioning. Therefore, it is possible that since the patient had subclinical lung damage, she suffered from pneumonitis induced by G-CSF.

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  1. Diivision of Cell Transplantation and Transfusion, Jichi Medical School, 3311–1 Yakushiji, Minamikawachi, 329-0498, Tochigi, Japan

    C Kawano & K Muroi

  2. Department of Hematology, Jichi Medical School, 3311–1 Yakushiji, Minamikawachi, 329-0498, Tochigi, Japan

    C Kawano, K Muroi, R Kuribara, Y Matsumoto, T Ohtsuki & K Hatake

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Kawano, C., Muroi, K., Kuribara, R. et al. Engraftment syndrome after autologous peripheral blood stem cell transplantation with high numbers of peripheral blood stem cells followed by granulocyte colony-stimulating factor administration. Bone Marrow Transplant 25, 228–229 (2000). https://doi.org/10.1038/sj.bmt.1702110

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