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• W2018698511 abstract "Engraftment syndrome (ES) after autologous hematopoietic stem cell transplantation (AHSCT) is defined by the presence of a new fever (> 38°C) without clinical or microbiologic documentation of infection or response to antimicrobial agents; an erythrodermatous rash involving > 25% of the body surface area and not attributable to a medication; and noncardiogenic pulmonary edema, manifested by diffuse pulmonary infiltrates and hypoxia.1 Engraftment syndrome is believed to be caused by the release of proinflammatory cytokines, such as interleukin-1, tumor necrosis factor– , and interferon, resulting in systemic tissue injury. Local injury is reflected by sequestration of neutrophils in the lungs, although systemic symptoms can be represented by fever and a diffuse increase in capillary permeability.2 The onset of ES typically occurs approximately 7 days after AHSCT, with a median duration of 11 days.3 The incidence of ES varies from 7% to 59%. Engraftment syndrome is usually a self-limited process but can be associated with an increase in the duration of hospitalization. The awareness of posttransplantation ES has resulted in the implementation of early steroid therapy and a rapid reversal of the disorder. Engraftment syndrome is not commonly seen in multiple myeloma.4 We report our retrospective observations in 90 consecutive patients with multiple myeloma who underwent autologous stem cell transplantation after high-dose melphalan therapy from 2002 to 2004 at a single institution. We identified 9 cases of ES, for an overall incidence of 10%. The characteristics of ES in these 9 patients are shown in Table 1. All 9 patients developed a fever (temperature > 100.4°F). Eight of 9 patients (89%) developed noninfectious diarrhea. Rash was present in 4 of 9 patients (44%), and 6 of 9 patients (66%) demonstrated pulmonary infiltrates on chest radiograph. Four patients were given steroids for hypoxia associated with ES, with prompt responses in 3 patients. One patient failed to respond to high-dose steroids and died from multisystem failure. It is not clear whether this patient had ES or if another clinically similar entity led to the patient’s death. Also, steroids in that case were given late in the course (day 17). Engraftment syndrome remains an important entity to recognize in patients undergoing AHSCT, because early recognition leads to prompt treatment and recovery. We report a 10% incidence of ES in multiple myeloma, a much higher frequency than previously reported. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _" @default.
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• W2018698511 date "2006-09-01" @default.
• W2018698511 modified "2023-09-27" @default.
• W2018698511 title "Engraftment Syndrome After Hematopoietic Stem Cell Transplantation in Multiple Myeloma" @default.
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• W2018698511 doi "https://doi.org/10.1016/s1557-9190(11)70311-0" @default.
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