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Pre-engraftment syndrome after myeloablative dual umbilical cord blood transplantation: risk factors and response to treatment.

Publication ,  Journal Article
Kanda, J; Kaynar, L; Kanda, Y; Prasad, VK; Parikh, SH; Lan, L; Shen, T; Rizzieri, DA; Long, GD; Sullivan, KM; Gasparetto, C; Chute, JP ...
Published in: Bone Marrow Transplant
July 2013

High fevers and/or rashes prior to neutrophil engraftment are frequently observed after umbilical cord blood (UCB) transplantation, and the condition is referred to as pre-engraftment syndrome (PES). Few studies have evaluated the risk factors for and treatment response to PES. Therefore, we retrospectively characterized PES in 57 consecutive engrafted patients (≥ 12 years old) who received myeloablative dual UCB transplantation. All patients received TBI (≥ 13.2 Gy)-based myeloablative conditioning. Tacrolimus (n=35) or CYA (n=22) combined with mycophenolate mofetil was used as GVHD prophylaxis. PES was defined as the presence of non-infectious fever (≥ 38.5 °C) and/or rash prior to or on the day of neutrophil engraftment. The incidence (95% confidence interval) of PES was 77% (66-88%). The incidence of PES was significantly higher in patients who received CYA as a GVHD prophylaxis than those who received tacrolimus (P<0.001), and this association was confirmed in the multivariate analysis. The occurrence of PES did not impact OS or tumor relapse, although it may have increased non-relapse mortality (P=0.071). The incidence of acute GHVD or treatment-related mortality was not influenced by the choice to use corticosteroids to treat PES. This study suggests that use of CYA for GVHD prophylaxis increases the risk of PES following dual UCB transplantation.

Duke Scholars

Published In

Bone Marrow Transplant

DOI

EISSN

1476-5365

Publication Date

July 2013

Volume

48

Issue

7

Start / End Page

926 / 931

Location

England

Related Subject Headings

  • Transplantation Conditioning
  • Tacrolimus
  • Syndrome
  • Risk Factors
  • Neutrophils
  • Mycophenolic Acid
  • Middle Aged
  • Male
  • Incidence
  • Immunosuppressive Agents
 

Citation

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Chicago
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Kanda, J., Kaynar, L., Kanda, Y., Prasad, V. K., Parikh, S. H., Lan, L., … Horwitz, M. E. (2013). Pre-engraftment syndrome after myeloablative dual umbilical cord blood transplantation: risk factors and response to treatment. Bone Marrow Transplant, 48(7), 926–931. https://doi.org/10.1038/bmt.2012.279
Kanda, J., L. Kaynar, Y. Kanda, V. K. Prasad, S. H. Parikh, L. Lan, T. Shen, et al. “Pre-engraftment syndrome after myeloablative dual umbilical cord blood transplantation: risk factors and response to treatment.Bone Marrow Transplant 48, no. 7 (July 2013): 926–31. https://doi.org/10.1038/bmt.2012.279.
Kanda J, Kaynar L, Kanda Y, Prasad VK, Parikh SH, Lan L, et al. Pre-engraftment syndrome after myeloablative dual umbilical cord blood transplantation: risk factors and response to treatment. Bone Marrow Transplant. 2013 Jul;48(7):926–31.
Kanda, J., et al. “Pre-engraftment syndrome after myeloablative dual umbilical cord blood transplantation: risk factors and response to treatment.Bone Marrow Transplant, vol. 48, no. 7, July 2013, pp. 926–31. Pubmed, doi:10.1038/bmt.2012.279.
Kanda J, Kaynar L, Kanda Y, Prasad VK, Parikh SH, Lan L, Shen T, Rizzieri DA, Long GD, Sullivan KM, Gasparetto C, Chute JP, Morris A, Winkel S, McPherson J, Kurtzberg J, Chao NJ, Horwitz ME. Pre-engraftment syndrome after myeloablative dual umbilical cord blood transplantation: risk factors and response to treatment. Bone Marrow Transplant. 2013 Jul;48(7):926–931.

Published In

Bone Marrow Transplant

DOI

EISSN

1476-5365

Publication Date

July 2013

Volume

48

Issue

7

Start / End Page

926 / 931

Location

England

Related Subject Headings

  • Transplantation Conditioning
  • Tacrolimus
  • Syndrome
  • Risk Factors
  • Neutrophils
  • Mycophenolic Acid
  • Middle Aged
  • Male
  • Incidence
  • Immunosuppressive Agents