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Dexamethasone palmitate for patients with engraftment syndrome is associated with favorable outcome for children with hematological malignancy

Bone Marrow Transplantation volume 51, pages 1540–1542 (2016)Cite this article

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Engraftment syndrome (ES) is an early complication of hematopoietic stem cell transplantation (HSCT), characterized by non-infectious high-grade fever, skin eruptions in the absence of infection or drug toxicity, non-cardiac pulmonary infiltrate, body weight gain, diarrhea and/or jaundice.1 Although the pathogenesis of ES is poorly understood, activated macrophages have crucial roles in both the innate and acquired immune pathways during the peri-engraftment period.2, 3 Several reports have demonstrated that immune suppressive agents, such as corticosteroids, could control the peri-engraftment immune reactions after HSCT, but ES has been associated with a higher prevalence of acute GvHD and higher non-relapse mortality (NRM).4, 5, 6, 7, 8, 9 In particular, viral infections as a consequence of long-term steroid administration after HSCT often have fatal outcomes. Liposome-incorporated dexamethasone or dexamethasone palmitate (DP), which is readily taken up by macrophages via phagocytosis and strongly retained in the cytoplasm, is known to suppress macrophage activation.10 Nishiwaki et al.11 reported that DP reduced the number of primary human macrophages in vitro more rapidly and profoundly than dexamethasone sodium phosphate, and that DP treatment suppressed the activity of macrophages and prevented the engraftment failure in three patients with hemophagocytic syndrome after HSCT.

To assess the efficacy and feasibility of DP treatment for ES and to evaluate the clinical impact on transplantation outcomes, we reviewed the cases of 95 consecutive children with allogeneic HSCT for hematological malignancy treated at our institute between 2006 and 2014.

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Acknowledgements

We wish to thank all of the staff who contributed to patient care at our institute. This study was partially supported by a grant from the National Center for Child Health and Development (grant number 26-14), Tokyo, Japan.

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Authors and Affiliations

  1. Department of Hematology and Oncology, Children’s Medical Center, Japanese Red Cross Nagoya First Hospital, Nagoya, Japan

    H Sakaguchi, N Yoshida, K Narita, M Hamada, S Kataoka, N Miyagawa & K Kato

  2. Children’s Cancer Center, National Center for Child Health and Development, Tokyo, Japan

    K Matsumoto

  3. Department of Pediatrics, Fujita Health University School of Medicine, Toyoake, Japan

    T Yoshikawa

  4. Department of Pathology, Japanese Red Cross Nagoya First Hospital, Nagoya, Japan

    M Ito

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  1. H Sakaguchi
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  2. K Matsumoto
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  3. N Yoshida
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  5. M Hamada
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  10. K Kato
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Correspondence to H Sakaguchi.

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Sakaguchi, H., Matsumoto, K., Yoshida, N. et al. Dexamethasone palmitate for patients with engraftment syndrome is associated with favorable outcome for children with hematological malignancy. Bone Marrow Transplant 51, 1540–1542 (2016). https://doi.org/10.1038/bmt.2016.178

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