Peri-engraftment Syndrome in Allogeneic Hematopoietic SCT

Bone Marrow Transplant. 2013 Apr;48(4):523-8. doi: 10.1038/bmt.2012.171. Epub 2012 Sep 24.


Engraftment syndrome (ES) and pre-engraftment syndrome (pre-ES) are both inflammatory conditions that occur after hematopoietic SCT (HSCT) and are characterized by non-infectious fever and skin rash. Although the pathogenesis is not fully understood, both syndromes are similar, and could be defined as a new clinical syndrome, named as peri-engraftment syndrome (peri-ES). We retrospectively analyzed the clinical records in 176 pediatric patients, following allogeneic HSCT. We utilized the definition of ES by Spitzer as the diagnostic criteria, excluding 'within 96 h of engraftment' criteria. Thirty cases developed peri-ES with a cumulative incidence of 17.0%. High cumulative incidence (50%) was seen in patients who underwent a double-unit cord blood transplantation (DUCBT; P<0.01). Clinical findings of peri-ES are similar, regardless of the onset day, and encephalopathy was the most severe complication. In the DUCBT cohort, the use of TBI and early complete chimerism (≤ day 21) were identified as risk factors that predispose the development of peri-ES. We determined that both, ES and pre-ES, might have similar causes, which could be included in peri-ES. Particularly, it occurred more in DUCBT patients, which means that not only neutrophil engraftment but also immune reactions within the two units might contribute to peri-ES.

Publication types

  • Clinical Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Child
  • Child, Preschool
  • Cord Blood Stem Cell Transplantation*
  • Exanthema* / epidemiology
  • Exanthema* / etiology
  • Exanthema* / immunology
  • Exanthema* / pathology
  • Exanthema* / physiopathology
  • Female
  • Fever* / epidemiology
  • Fever* / etiology
  • Fever* / immunology
  • Fever* / pathology
  • Fever* / physiopathology
  • Graft Survival / immunology*
  • Hematologic Neoplasms / epidemiology
  • Hematologic Neoplasms / immunology
  • Hematologic Neoplasms / pathology
  • Hematologic Neoplasms / therapy
  • Hematopoietic Stem Cell Transplantation*
  • Humans
  • Incidence
  • Infant
  • Male
  • Medical Records
  • Neutrophils* / immunology
  • Neutrophils* / pathology
  • Retrospective Studies
  • Risk Factors
  • Syndrome
  • Transplantation Chimera / immunology
  • Transplantation, Homologous