Abstract
Engraftment syndrome (ES) is a toxicity of autologous stem cell transplantation that occurs unexpectedly and is occasionally fatal. This syndrome, manifested as fever, rash and pulmonary deterioration which becomes evident at marrow engraftment, has been described by several centers but as yet remains enigmatic. We describe this syndrome at a single institution and note that it has accompanied the transition from the use of autologous marrow rescue to peripheral blood stem cell rescue. In this study, the occurrence of ES is related to the mononuclear cell dose at reinfusion. We found, in agreement with other reports, that patients developing ES are predominantly women undergoing therapy for solid tumors who demonstrate neutrophil engraftment at a significantly greater rate than do those patients not expressing the syndrome. We did not note a significant relationship between growth factor use (G-CSF) or amphotericin B exposure and the syndrome, as has been previously reported. The progenitor cell populations obtained with autologous marow and peripheral blood stem cells are different. We hypothesize that the interaction of committed myeloid precursors from the stem cell product with the pulmonary vascular endothelium can be deleterious, especially under the influence of the inflammatory cytokines present at the time of engraftment. Bone Marrow Transplantation (2000) 25, 405–409.
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References
Hryniuk W, Bush H . The importance of dose intensity in chemotherapy for metastatic breast cancer J Clin Oncol 1984 2: 1281–1288
Cahill RA, Spitzer TR, Mazumder A . Marrow engraftment and clinical manifestations of the capillary leak syndrome Bone Marrow Transplant 1996 18: 177–184
Lee C-K, Gingrich RJ, Hohl RJ, Ajram KA . Engraftment syndrome in autologous marrow and peripheral stem cell transplantation Bone Marrow Transplant 1995 16: 175–182
Moreb JS, Kubilis PS, Mullins DL et al. Increased frequency of autoaggression syndrome associated with autologous stem cell transplantation in breast cancer patients Bone Marrow Transplant 1997 19: 101–106
Ravoet C, Feremans W, Husson B et al. Clinical evidence for an engraftment syndrome associated with early and steep neutrophil recovery after autologous blood stem cell transplantation Bone Marrow Transplant 1996 18: 943–947
Radford J, Pest E, Weisdorf D . Cytokine-stimulated engraftment syndrome (ES) after high dose chemotherapy (HDC) with bone marrow (BM) and G-CSF-primed peripheral stem cell (GPSC) rescue Blood 1994 84: (Suppl. 1) 490a
Goodman JL, Winston DJ, Greenfield RA et al. A controlled trial of fluconazole to prevent fungal infections in patients undergoing bone marrow transplantation New Engl J Med 1992 326: 845–851
Wright DG, Meierovics AI, Foxley JM . Assessing the delivery of neutrophils to tissues in neutropenia Blood 1986 67: 1023–1030
Allen J, Cooper D, White DA, Matthay RA . Drug-induced pulmonary disease: Part 1: cytotoxic drugs Am Rev Respir Dis 1986 133: 321–340
Spector JI, Zimbler H, Ross JS . Early-onset cyclophosphamide-induced interstitial pneumonitis JAMA 1979 242: 2852–2854
Gould VE, Miller J . Sclerosing alveolitis induced by cyclophosphamide Am J Pathol 1975 81: 513–530
Patel AR, Shah PC, Rhee HL et al. Cyclophosphamide therapy and interstitial pulmonary fibrosis Cancer 1976 38: 1542–1549
Bender JG, Unverzagt KL, Walker DE et al. Identification and comparison of CD34-positive cells and their subpopulations from normal peripheral blood and bone marrow using multi-color flow cytometry Blood 1991 77: 2591–2596
Weiss SJ . Tissue destruction by neutrophils New Engl J Med 1989 320: 365–376
Gee MH, Albertine KH . Neutrophil-endothelial cell interactions in the lung Annu Rev Physiol 1993 55: 227–248
Chollet-Martin S, Jourdain B, Gibert C et al. Interactions between neutrophils and cytokines in blood and alveolar spaces during ARDS Am J Respir Crit Care Med 1996 153: 594–601
McDonnell TJ, Chang S-W, Westcott JY, Voelkel NF . Role of oxidants, eicosenoids, and neutrophils in amphotericin B lung injury in rats J Appl Physiol 1988 65: 2195–2206
Haber RH, Oddone PA, Gurbel PA, Stead WW . Acute pulmonary decompensation due to amphotericin B in the absence of granulocyte transfusions New Engl J Med 1986 315: 836–841
Berliner S, Weinberger M, Ben-Bassat M et al. Amphotericin B causes aggregation of neutrophils and enhances pulmonary leukostasis Am Rev Respir Dis 1985 132: 602–605
Wright DG, Robichaud KJ, Pizzo PA, Deisseroth AB . Lethal pulmonary reactions associated with the use of amphotericin B and leukocyte transfusions New Engl J Med 1981 304: 1185–1189
Kodo H, Tajika K, Takahashi S et al. Acceleration of neutrophilic granulocyte recovery after bone-marrow transplantation by administration of recombinant human granulocyte colony-stimulating factor Lancet 1988 ii: 38–39
Zsebo KM, Cohen AM, Murdock DC et al. Recombinant human granulocyte colony stimulating factor: molecular and biologic characterization Immunobiol 1986 172: 174–184
Humphreys JM, Rugman FP, Davies JM et al. Effects of recombinant human granulocyte colony-stimulating factor on neutrophil function in vitro and in vivo following chemotherapy and autologous bone marrow transplantation J Clin Lab Immunol 1991 34: 55–61
Oshaka A, Kitagawa S, Sakamoto S et al. In vivo activation of human neutrophil functions by administration of recombinant human granulocyte colony-stimulating factor in patients with malignant lymphoma Blood 1989 74: 2743–2748
Rabinowitz J, Petros WP, Stuart AR, Peters WP . Characterization of endogenous cytokine concentrations after high dose chemotherapy with autologous bone marrow support Blood 1993 81: 2452–2459
Chasty RC, Lamb WR, Gallati H et al. Serum cytokine levels in patients undergoing bone marrow transplantation Bone Marrow Transplant 1993 12: 331–336
Holler E, Kolb HJ, Moller A et al. Increased levels of tumor necrosis factor alpha precede major complications of bone marrow transplantation Blood 1990 75: 1011–1016
Acknowledgements
We wish to express gratitude for the support of the ward 71 staff for assistance during this review, and the support from the Department of Clinical Investigation, Walter Reed Army Medical Center.
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Edenfield, W., Moores, L., Goodwin, G. et al. An engraftment syndrome in autologous stem cell transplantation related to mononuclear cell dose. Bone Marrow Transplant 25, 405–409 (2000). https://doi.org/10.1038/sj.bmt.1702155
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DOI: https://doi.org/10.1038/sj.bmt.1702155
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