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Pre-engraftment syndrome after unrelated cord blood transplantation: a predictor of engraftment and acute graft-versus-host disease.

Authors
Park, M; Lee, SH; Lee, YH; Yoo, KH; Sung, KW; Koo, HH; Kang, HJ; Park, KD; Shin, HY; Ahn, HS; Chung, NG; Cho, B; Kim, HK; Koh, KN; Im, HJ; Seo, JJ; Han, DK; Baek, HJ; Kook, H; Hwang, TJ; Lee, EK; Hah, JO; Lim, YJ; Jung, HJ; Park, JE; Jang, MJ; Chong, SY; Oh, D; Korean Cord Blood Transplantation Working Party
Citation
Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation, 19(4):640-646, 2013
Journal Title
Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation
ISSN
1083-87911523-6536
Abstract
Pre-engraftment syndrome (PES) is poorly characterized, and its clinical significance and the prognostic impact after unrelated cord blood transplantation (CBT) are unclear. To address these issues, we retrospectively analyzed the incidence, risk factors, and clinical outcomes of PES in unrelated CBT recipients. Data of 381 patients who received unrelated CBT from 18 medical centers in Korea were reviewed. PES was defined as unexplained fever >38.3°C not associated with infection, and/or unexplained skin rash with or without evidence of fluid retention before neutrophil recovery. PES developed in 102 patients (26.8%) at a median of 7 days after CBT. Of these patients, 74 patients (72.5%) received intravenous corticosteroid at a median dose of 1 mg/kg/day, and of these, 95% showed clinical improvement. Risk factors for developing PES included low risk disease, myeloablative conditioning, graft-versus-host disease (GVHD) prophylaxis without methotrexate or corticosteroid, and >5.43 x 10(7)/kg infused nucleated cells. Absence of PES was one of the risk factors for graft failure in multivariate analysis. The cumulative incidence of grade II to grade IV acute GVHD by 100 days after CBT was higher in patients with PES than in those without PES (56.0% versus 34.4%, P < .01). PES was not associated with chronic GVHD, treatment-related mortality, relapse, or overall survival. PES seems to be common after CBT and may be associated with enhanced engraftment without significant morbidity.
MeSH terms
Acute DiseaseAdolescentAdrenal Cortex Hormones/*therapeutic useAdultAgedChildChild, Preschool*Cord Blood Stem Cell TransplantationFemaleGraft Rejection/prevention & controlGraft Survival/*immunologyGraft vs Host Disease/*immunology/mortality/prevention & control/*therapyHumansInfantMaleMiddle AgedMyeloablative Agonists/therapeutic usePrognosisRetrospective StudiesSeverity of Illness IndexSkin/immunology/pathologySurvival AnalysisSyndromeTransplantation ConditioningTransplantation, HomologousUnrelated Donors
DOI
10.1016/j.bbmt.2013.01.014
PMID
23380345
Appears in Collections:
Journal Papers > School of Medicine / Graduate School of Medicine > Pediatrics & Adolescent Medicine
AJOU Authors
정, 현주박, 준은
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