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Xingbing Wang - One of the best experts on this subject based on the ideXlab platform.
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Pre-Engraftment Syndrome After Myeloablative Umbilical Cord Blood Transplantation: Risk Factors and How To Stratify
Blood, 2013Co-Authors: Mao-jing Guan, Xingbing Wang, Liangquan Geng, Juan Tong, Changcheng Zheng, Baolin TangAbstract:Introduction Pre-Engraftment Syndrome (PES) is a group of symptoms occurred after hematopoietic stem cell transplantation especially unrelated cord blood transplantation(UCBT) before the Engraftment, including unexplained fever higher than 38.3°CAunexplained erythematous skin rashAdiarrheaAhepatic dysfunction Anon-cardiogenic edemaApulmonary infiltrates and weight gain. Severe PES can be fatal, however there’s no criteria to define it. We retrospectively analyzed the incidence, risk factors, manifestations and clinical outcomes of PES in CBT recipients, who had been treated for hematologic malignancies. All patients received TBI(12GY)/Ara-c(8g/ m2)/CY(120mg/kg) without ATG or Flu(120mg/ m2)/Ara-c(8g/ m2)+BU(12.8mg/kg)+CY (120mg/kg) myeloablative conditioning. Methods From April 2010 to July 2011, 61 patients underwent UCBT at our transplantation center and 40 patients(65.6%) developed PES at a median of 7 d (range 5–13) post-transplant. We analyze 8 factors related to treatment-related mortality (TRM) within 180 days : occurrence timeAthe maximum temperatureAclinical symptomsAconcentration of CyclosporinAthe initial dose of MPAmethylprednisolone (MP) effective daysAdays till MP reduced and reoccurrence after symptoms under control. Univariate analysis identified early occurrence time( day +5 or +6 ) AMP effective days and clinical symptoms as significant risk factors for higher TRM. In a multivariate analysis, we found these three factors are independent and have no interactions. We retrospectively analyze all the patients who developed PES from April 2010 to December 2012. Results There were 94 cases and we scored them based on these three factors. The patient got one score for each factor if he/she got a fever on day 5-6 after UCBT or had more than two clinical symptoms or not under control after 7 days of MP. We added the three scores together and divide the patients into four groups according to the total score(zero for Group 1Aone score for Group 2Atwo score for Group 3Athree for Group 4). The number of patients for Group 1-4 was 32A32A18 and 12. There is a significant difference for the TRM within 180 days between Group 4(58%) and Group 1(18.7%)AGroup 2(22.2%) (P
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pre Engraftment Syndrome after myeloablative umbilical cord blood transplantation risk factors and how to stratify
Blood, 2013Co-Authors: Mao-jing Guan, Xingbing Wang, Liangquan Geng, Juan Tong, Changcheng Zheng, Baolin TangAbstract:Introduction Pre-Engraftment Syndrome (PES) is a group of symptoms occurred after hematopoietic stem cell transplantation especially unrelated cord blood transplantation(UCBT) before the Engraftment, including unexplained fever higher than 38.3°CAunexplained erythematous skin rashAdiarrheaAhepatic dysfunction Anon-cardiogenic edemaApulmonary infiltrates and weight gain. Severe PES can be fatal, however there’s no criteria to define it. We retrospectively analyzed the incidence, risk factors, manifestations and clinical outcomes of PES in CBT recipients, who had been treated for hematologic malignancies. All patients received TBI(12GY)/Ara-c(8g/ m2)/CY(120mg/kg) without ATG or Flu(120mg/ m2)/Ara-c(8g/ m2)+BU(12.8mg/kg)+CY (120mg/kg) myeloablative conditioning. Methods From April 2010 to July 2011, 61 patients underwent UCBT at our transplantation center and 40 patients(65.6%) developed PES at a median of 7 d (range 5–13) post-transplant. We analyze 8 factors related to treatment-related mortality (TRM) within 180 days : occurrence timeAthe maximum temperatureAclinical symptomsAconcentration of CyclosporinAthe initial dose of MPAmethylprednisolone (MP) effective daysAdays till MP reduced and reoccurrence after symptoms under control. Univariate analysis identified early occurrence time( day +5 or +6 ) AMP effective days and clinical symptoms as significant risk factors for higher TRM. In a multivariate analysis, we found these three factors are independent and have no interactions. We retrospectively analyze all the patients who developed PES from April 2010 to December 2012. Results There were 94 cases and we scored them based on these three factors. The patient got one score for each factor if he/she got a fever on day 5-6 after UCBT or had more than two clinical symptoms or not under control after 7 days of MP. We added the three scores together and divide the patients into four groups according to the total score(zero for Group 1Aone score for Group 2Atwo score for Group 3Athree for Group 4). The number of patients for Group 1-4 was 32A32A18 and 12. There is a significant difference for the TRM within 180 days between Group 4(58%) and Group 1(18.7%)AGroup 2(22.2%) (P<0.01). The TRM of Group 4 in one year is 66.7%, which is significantly higher than Group 1( 22.7%), Group 3(22.2%) (P<0.01), but shows less significant difference compared with TRM of group 2, which is 33%. The relapse rate of one year for each group from 1 to 4 was 9%A16.7%A5.5%A8.3%. The probability of one-year disease-free survival (DFS) was much higher in Group 1 (71.7%) and 3(72.2%) than Group 4(25%) (P<0.01). The difference was apparent as to the probability of one-year overall survival (OS) between Group 1 (74.8%) and 4(25%), the same is true whith Group 3 (71.3%) and 4(25%). The difference between Group 2(55.4%) and Group 4 was not clearly significant (P=0.06). Conclusions Recognizing and treating immediately severe PES will significantly reduce the TRM of UCBT. Our analyze confirmed that these three factors are crucial to define severe PES .We therefore put forward this ranking method to help to diagnosis and take effective treatment. Disclosures: No relevant conflicts of interest to declare.
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pre Engraftment Syndrome after unrelated donor umbilical cord blood transplantation in patients with hematologic malignancies
European Journal of Haematology, 2012Co-Authors: Xingbing Wang, Liangquan Geng, Kaiyang Ding, Lailing Li, Juan TongAbstract:Pre-Engraftment Syndrome (PES) after umbilical cord blood transplantation (CBT) remains poorly characterized, and the prognosis and appropriate management are unclear. Therefore, we retrospectively analyzed the incidence, risk factors, manifestations, and clinical outcomes of PES in CBT recipients, who had been treated for hematologic malignancies at our transplantation center. PES was defined as unexplained fever higher than 38.3°C that is not associated with documented infection and unresponsive to antimicrobial manipulations and/or unexplained erythematous skin rash occurring prior to neutrophil Engraftment. A total of 81 patients (median 18 yr, range 3–48) received either myeloablative (n = 72) or non-myeloablative (n = 9) conditioning. Neutrophil Engraftment was achieved in 69 of the 81 cases [86.2%, 95% confidence interval (CI) = 78.9–94.1%], and the median time to more than 0.5 × 109/L ANC was 19 d (range, 12–39). Fifty-one patients (63.0%) developed PES at a median of 7 d (range 3–15) post-transplant: 46 patients had both rash and unexplained fever; one patient had unexplained fever alone; and four patients had rash only. Forty-seven patients (92.2%) received IV methylprednisolone (MP) at a median dose of 1 mg/kg (range 0.4–3). All patients treated with MP responded as evidenced by fever resolution combined with resolution of rash. All patients with PES had high serum levels of C-reactive protein (CRP), which were significantly reduced after effective steroid treatment. Univariate analysis identified myeloablative conditioning and younger age as significant risk factors for developing PES. Cumulative incidence of grade II–IV acute graft-versus-host disease (aGVHD) in the PES+ and PES− groups was 51.5% (95% CI = 38.0–70.0%) and 17.0% (95% CI = 6.9–41.7%), respectively. In a multivariate analysis, we found significantly increased risk of grade II–IV aGVHD among PES patients (P = 0.041). However, PES was not associated with sustained donor Engraftment, the day to neutrophil recovery, chronic graft-versus-host disease, transplant-related mortality at day 180, and overall survival. Despite of the inherent limitations of this small retrospective study, PES seemed to be common after CBT and associated with high incidence of aGVHD.
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Pre‐Engraftment Syndrome after unrelated donor umbilical cord blood transplantation in patients with hematologic malignancies
European Journal of Haematology, 2011Co-Authors: Xingbing Wang, Liangquan Geng, Kaiyang Ding, Lailing Li, Juan TongAbstract:Pre-Engraftment Syndrome (PES) after umbilical cord blood transplantation (CBT) remains poorly characterized, and the prognosis and appropriate management are unclear. Therefore, we retrospectively analyzed the incidence, risk factors, manifestations, and clinical outcomes of PES in CBT recipients, who had been treated for hematologic malignancies at our transplantation center. PES was defined as unexplained fever higher than 38.3°C that is not associated with documented infection and unresponsive to antimicrobial manipulations and/or unexplained erythematous skin rash occurring prior to neutrophil Engraftment. A total of 81 patients (median 18 yr, range 3–48) received either myeloablative (n = 72) or non-myeloablative (n = 9) conditioning. Neutrophil Engraftment was achieved in 69 of the 81 cases [86.2%, 95% confidence interval (CI) = 78.9–94.1%], and the median time to more than 0.5 × 109/L ANC was 19 d (range, 12–39). Fifty-one patients (63.0%) developed PES at a median of 7 d (range 3–15) post-transplant: 46 patients had both rash and unexplained fever; one patient had unexplained fever alone; and four patients had rash only. Forty-seven patients (92.2%) received IV methylprednisolone (MP) at a median dose of 1 mg/kg (range 0.4–3). All patients treated with MP responded as evidenced by fever resolution combined with resolution of rash. All patients with PES had high serum levels of C-reactive protein (CRP), which were significantly reduced after effective steroid treatment. Univariate analysis identified myeloablative conditioning and younger age as significant risk factors for developing PES. Cumulative incidence of grade II–IV acute graft-versus-host disease (aGVHD) in the PES+ and PES− groups was 51.5% (95% CI = 38.0–70.0%) and 17.0% (95% CI = 6.9–41.7%), respectively. In a multivariate analysis, we found significantly increased risk of grade II–IV aGVHD among PES patients (P = 0.041). However, PES was not associated with sustained donor Engraftment, the day to neutrophil recovery, chronic graft-versus-host disease, transplant-related mortality at day 180, and overall survival. Despite of the inherent limitations of this small retrospective study, PES seemed to be common after CBT and associated with high incidence of aGVHD.
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pre Engraftment Syndrome following umbilical cord blood transplantation is a strong predictor of acute graft versus host disease
Blood, 2010Co-Authors: Xingbing Wang, Liangquan Geng, Kaiyang Ding, Zuyi WangAbstract:Abstract 1267 Pre-Engraftment Syndrome (PES) has been described in patients receiving umbilical cord blood transplantation (CBT). However, PES remains poorly characterized, and the prognosis and appropriate management are unclear. Therefore, we retrospectively analyzed the incidence, risk factors, manifestations, and clinical outcome of PES in CBT recipients treated for hematological malignancies at our transplantation center. A total of 60 patients (median 20 years, range 3–48) received either myeloablative (n=52) or reduced-intensity (n=8) conditioning. 28 patients received double unit grafts to augment Engraftment. Cyclosporine-A and mycophenolate mofetil were used as GVHD prophylaxis, and all patients received post-transplant granulocyte colony-stimulating factor. In this study, PES was defined as noninfectious fever (>38.3°C) and/or unexplained rash occurring before neutrophil Engraftment. 38 patients (63.3%) fulfilled PES criteria: 33 with fever and 36 with rash. The median onset was 8 days (range 3–15) post-transplant (a median of 12 days before neutrophil recovery) . 34 patients received IV methylprednisolone (MP) (0.5-2 mg/kg/d) with 27/34 (79.4%) having fever and/or rash resolution in We conclude that PES is common following CB transplant (CBT), predicts for aGVHD, and responds promptly to corticosteroids. Disclosures: Wang: Fund of the Key Medical Project of Anhui Provincial healthy department (2010A005): Research Funding; Clinical Technology foundation of Anhui Provincial healthy department (2008A011): Research Funding; Fund of Anhui Provincial “115” Industrial Innovation Program: Research Funding; Anhui Provincial Outstanding Young Investigator Program (08040106810): Research Funding.
Liangquan Geng - One of the best experts on this subject based on the ideXlab platform.
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The Efficacy of Risk Score System Establishment and Methylprednisolone Stratification Treatment for Pre-Engraftment Syndrome after Unrelated Cord Blood Transplantation: A Retrospective (development) and a Prospective (validation) Study
Blood, 2019Co-Authors: Baolin Tang, Liangquan Geng, Changcheng Zheng, Kaidi Song, Xuhan ZhangAbstract:Introduction Pre-Engraftment Syndrome (PES) is a common immune reaction prior to neutrophil Engraftment after unrelated cord blood transplantation (UCBT), with a unique clinical manifestation of non-infectious fever and skin rash. The reported incidence of PES ranges from 20% to 78%. Although many researchers believe that PES is associated with a high incidence of acute graft-versus-host disease (GVHD) but not with transplant-related mortality (TRM) , relapse, or overall survival (OS), they did not stratify the risk factors of PES, and how to carry out different doses of methylprednisolone (MP) stratified intervention therapy still remains unknown. Method s First, 136 hematological malignancy patients treated with UCBT from April 2000 to February 2012 in our transplantation center were retrospectively analysis. Among them, 92 patients occurred PES. High-risk factors for 180-day TRM in PES patients were established by univariate and multivariate analysis. Then, from January 2013 to August 2016, 221 PES patients were scored according to the risk scoring system and stratified treated with different doses of MP. Finally, in order to validate the efficacy of MP stratification treatment, we conducted a prospective, open label and non-randomized clinical trial including 240 PES patients who underwent UCBT from September 2016 to December 2018. This trial is registered at www.chictr.org.cn as ChiCTR-ONC-16009013. Results The cumulative incidence of neutrophil and platelet Engraftment was significantly higher in PES group than non-PES group (97.8% vs 70.5%, P<0.001; 75.0% vs 54.5%, P=0.05). In 92 PES patients, multivariate analysis showed that failed MP treatment, multiple clinical symptoms and early onset of PES were independent high risk factors affecting180-day TRM. One high risk factor was scored as 1. The 92 PES patients were divided into PES-0, PES-1,PES-2 and PES-3, and the higher the score, the higher the TRM (17.7% vs 21.9% vs 62.5% vs 100%,respectively; P<0.001), and the lower the OS (68.3% vs 56.2% vs 25.0% vs 0%, respectively; P<0.001). Then, from January 2013 to August 2016, 221 PES patients were scored as PES-0, PES-1 and PES-2 according to the following two high risk factors (multiple clinical symptoms and early onset of PES) and stratified treated with different doses of MP (0.5mg/kg/d for PES-0, 1mg/kg/d for PES-1 and 2mg/kg/d for PES-2). Compared to the previous PES patients with the same risk score, the 180-day TRM of PES-1 and PES-2 patients was significantly reduced and the OS, disease free survival (DFS), and GVHD-free and Relapse-free survival (GRFS) were significantly increased after stratified treatment. The results in the prospective trial were similar to the retrospective study. In addition, although stratified therapy could significantly improve the prognosis of PES-2 patients cohort, the cumulative incidence of acute GVHD and GRFS are still the worst compared with other risk score patients. Therefore, how to improve the outcomes of PES-2 patients remains to be further studied. Conclusion s PES after UCBT is benefit for Engraftment, but should be graded according the risk scoring system. Different doses of MP stratified intervention therapy can significantly improve the prognosis of severe PES patients. The risk scoring system of PES after UCBT and MP stratification treatment are worthy of clinical application. But the cumulative incidence of acute GVHD and GRFS in severe PES patients still need to be ameliorated in the further study. Disclosures No relevant conflicts of interest to declare.
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Pre-Engraftment Syndrome After Myeloablative Umbilical Cord Blood Transplantation: Risk Factors and How To Stratify
Blood, 2013Co-Authors: Mao-jing Guan, Xingbing Wang, Liangquan Geng, Juan Tong, Changcheng Zheng, Baolin TangAbstract:Introduction Pre-Engraftment Syndrome (PES) is a group of symptoms occurred after hematopoietic stem cell transplantation especially unrelated cord blood transplantation(UCBT) before the Engraftment, including unexplained fever higher than 38.3°CAunexplained erythematous skin rashAdiarrheaAhepatic dysfunction Anon-cardiogenic edemaApulmonary infiltrates and weight gain. Severe PES can be fatal, however there’s no criteria to define it. We retrospectively analyzed the incidence, risk factors, manifestations and clinical outcomes of PES in CBT recipients, who had been treated for hematologic malignancies. All patients received TBI(12GY)/Ara-c(8g/ m2)/CY(120mg/kg) without ATG or Flu(120mg/ m2)/Ara-c(8g/ m2)+BU(12.8mg/kg)+CY (120mg/kg) myeloablative conditioning. Methods From April 2010 to July 2011, 61 patients underwent UCBT at our transplantation center and 40 patients(65.6%) developed PES at a median of 7 d (range 5–13) post-transplant. We analyze 8 factors related to treatment-related mortality (TRM) within 180 days : occurrence timeAthe maximum temperatureAclinical symptomsAconcentration of CyclosporinAthe initial dose of MPAmethylprednisolone (MP) effective daysAdays till MP reduced and reoccurrence after symptoms under control. Univariate analysis identified early occurrence time( day +5 or +6 ) AMP effective days and clinical symptoms as significant risk factors for higher TRM. In a multivariate analysis, we found these three factors are independent and have no interactions. We retrospectively analyze all the patients who developed PES from April 2010 to December 2012. Results There were 94 cases and we scored them based on these three factors. The patient got one score for each factor if he/she got a fever on day 5-6 after UCBT or had more than two clinical symptoms or not under control after 7 days of MP. We added the three scores together and divide the patients into four groups according to the total score(zero for Group 1Aone score for Group 2Atwo score for Group 3Athree for Group 4). The number of patients for Group 1-4 was 32A32A18 and 12. There is a significant difference for the TRM within 180 days between Group 4(58%) and Group 1(18.7%)AGroup 2(22.2%) (P
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pre Engraftment Syndrome after myeloablative umbilical cord blood transplantation risk factors and how to stratify
Blood, 2013Co-Authors: Mao-jing Guan, Xingbing Wang, Liangquan Geng, Juan Tong, Changcheng Zheng, Baolin TangAbstract:Introduction Pre-Engraftment Syndrome (PES) is a group of symptoms occurred after hematopoietic stem cell transplantation especially unrelated cord blood transplantation(UCBT) before the Engraftment, including unexplained fever higher than 38.3°CAunexplained erythematous skin rashAdiarrheaAhepatic dysfunction Anon-cardiogenic edemaApulmonary infiltrates and weight gain. Severe PES can be fatal, however there’s no criteria to define it. We retrospectively analyzed the incidence, risk factors, manifestations and clinical outcomes of PES in CBT recipients, who had been treated for hematologic malignancies. All patients received TBI(12GY)/Ara-c(8g/ m2)/CY(120mg/kg) without ATG or Flu(120mg/ m2)/Ara-c(8g/ m2)+BU(12.8mg/kg)+CY (120mg/kg) myeloablative conditioning. Methods From April 2010 to July 2011, 61 patients underwent UCBT at our transplantation center and 40 patients(65.6%) developed PES at a median of 7 d (range 5–13) post-transplant. We analyze 8 factors related to treatment-related mortality (TRM) within 180 days : occurrence timeAthe maximum temperatureAclinical symptomsAconcentration of CyclosporinAthe initial dose of MPAmethylprednisolone (MP) effective daysAdays till MP reduced and reoccurrence after symptoms under control. Univariate analysis identified early occurrence time( day +5 or +6 ) AMP effective days and clinical symptoms as significant risk factors for higher TRM. In a multivariate analysis, we found these three factors are independent and have no interactions. We retrospectively analyze all the patients who developed PES from April 2010 to December 2012. Results There were 94 cases and we scored them based on these three factors. The patient got one score for each factor if he/she got a fever on day 5-6 after UCBT or had more than two clinical symptoms or not under control after 7 days of MP. We added the three scores together and divide the patients into four groups according to the total score(zero for Group 1Aone score for Group 2Atwo score for Group 3Athree for Group 4). The number of patients for Group 1-4 was 32A32A18 and 12. There is a significant difference for the TRM within 180 days between Group 4(58%) and Group 1(18.7%)AGroup 2(22.2%) (P<0.01). The TRM of Group 4 in one year is 66.7%, which is significantly higher than Group 1( 22.7%), Group 3(22.2%) (P<0.01), but shows less significant difference compared with TRM of group 2, which is 33%. The relapse rate of one year for each group from 1 to 4 was 9%A16.7%A5.5%A8.3%. The probability of one-year disease-free survival (DFS) was much higher in Group 1 (71.7%) and 3(72.2%) than Group 4(25%) (P<0.01). The difference was apparent as to the probability of one-year overall survival (OS) between Group 1 (74.8%) and 4(25%), the same is true whith Group 3 (71.3%) and 4(25%). The difference between Group 2(55.4%) and Group 4 was not clearly significant (P=0.06). Conclusions Recognizing and treating immediately severe PES will significantly reduce the TRM of UCBT. Our analyze confirmed that these three factors are crucial to define severe PES .We therefore put forward this ranking method to help to diagnosis and take effective treatment. Disclosures: No relevant conflicts of interest to declare.
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pre Engraftment Syndrome after unrelated donor umbilical cord blood transplantation in patients with hematologic malignancies
European Journal of Haematology, 2012Co-Authors: Xingbing Wang, Liangquan Geng, Kaiyang Ding, Lailing Li, Juan TongAbstract:Pre-Engraftment Syndrome (PES) after umbilical cord blood transplantation (CBT) remains poorly characterized, and the prognosis and appropriate management are unclear. Therefore, we retrospectively analyzed the incidence, risk factors, manifestations, and clinical outcomes of PES in CBT recipients, who had been treated for hematologic malignancies at our transplantation center. PES was defined as unexplained fever higher than 38.3°C that is not associated with documented infection and unresponsive to antimicrobial manipulations and/or unexplained erythematous skin rash occurring prior to neutrophil Engraftment. A total of 81 patients (median 18 yr, range 3–48) received either myeloablative (n = 72) or non-myeloablative (n = 9) conditioning. Neutrophil Engraftment was achieved in 69 of the 81 cases [86.2%, 95% confidence interval (CI) = 78.9–94.1%], and the median time to more than 0.5 × 109/L ANC was 19 d (range, 12–39). Fifty-one patients (63.0%) developed PES at a median of 7 d (range 3–15) post-transplant: 46 patients had both rash and unexplained fever; one patient had unexplained fever alone; and four patients had rash only. Forty-seven patients (92.2%) received IV methylprednisolone (MP) at a median dose of 1 mg/kg (range 0.4–3). All patients treated with MP responded as evidenced by fever resolution combined with resolution of rash. All patients with PES had high serum levels of C-reactive protein (CRP), which were significantly reduced after effective steroid treatment. Univariate analysis identified myeloablative conditioning and younger age as significant risk factors for developing PES. Cumulative incidence of grade II–IV acute graft-versus-host disease (aGVHD) in the PES+ and PES− groups was 51.5% (95% CI = 38.0–70.0%) and 17.0% (95% CI = 6.9–41.7%), respectively. In a multivariate analysis, we found significantly increased risk of grade II–IV aGVHD among PES patients (P = 0.041). However, PES was not associated with sustained donor Engraftment, the day to neutrophil recovery, chronic graft-versus-host disease, transplant-related mortality at day 180, and overall survival. Despite of the inherent limitations of this small retrospective study, PES seemed to be common after CBT and associated with high incidence of aGVHD.
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Pre‐Engraftment Syndrome after unrelated donor umbilical cord blood transplantation in patients with hematologic malignancies
European Journal of Haematology, 2011Co-Authors: Xingbing Wang, Liangquan Geng, Kaiyang Ding, Lailing Li, Juan TongAbstract:Pre-Engraftment Syndrome (PES) after umbilical cord blood transplantation (CBT) remains poorly characterized, and the prognosis and appropriate management are unclear. Therefore, we retrospectively analyzed the incidence, risk factors, manifestations, and clinical outcomes of PES in CBT recipients, who had been treated for hematologic malignancies at our transplantation center. PES was defined as unexplained fever higher than 38.3°C that is not associated with documented infection and unresponsive to antimicrobial manipulations and/or unexplained erythematous skin rash occurring prior to neutrophil Engraftment. A total of 81 patients (median 18 yr, range 3–48) received either myeloablative (n = 72) or non-myeloablative (n = 9) conditioning. Neutrophil Engraftment was achieved in 69 of the 81 cases [86.2%, 95% confidence interval (CI) = 78.9–94.1%], and the median time to more than 0.5 × 109/L ANC was 19 d (range, 12–39). Fifty-one patients (63.0%) developed PES at a median of 7 d (range 3–15) post-transplant: 46 patients had both rash and unexplained fever; one patient had unexplained fever alone; and four patients had rash only. Forty-seven patients (92.2%) received IV methylprednisolone (MP) at a median dose of 1 mg/kg (range 0.4–3). All patients treated with MP responded as evidenced by fever resolution combined with resolution of rash. All patients with PES had high serum levels of C-reactive protein (CRP), which were significantly reduced after effective steroid treatment. Univariate analysis identified myeloablative conditioning and younger age as significant risk factors for developing PES. Cumulative incidence of grade II–IV acute graft-versus-host disease (aGVHD) in the PES+ and PES− groups was 51.5% (95% CI = 38.0–70.0%) and 17.0% (95% CI = 6.9–41.7%), respectively. In a multivariate analysis, we found significantly increased risk of grade II–IV aGVHD among PES patients (P = 0.041). However, PES was not associated with sustained donor Engraftment, the day to neutrophil recovery, chronic graft-versus-host disease, transplant-related mortality at day 180, and overall survival. Despite of the inherent limitations of this small retrospective study, PES seemed to be common after CBT and associated with high incidence of aGVHD.
Juan Tong - One of the best experts on this subject based on the ideXlab platform.
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Pre-Engraftment Syndrome After Myeloablative Umbilical Cord Blood Transplantation: Risk Factors and How To Stratify
Blood, 2013Co-Authors: Mao-jing Guan, Xingbing Wang, Liangquan Geng, Juan Tong, Changcheng Zheng, Baolin TangAbstract:Introduction Pre-Engraftment Syndrome (PES) is a group of symptoms occurred after hematopoietic stem cell transplantation especially unrelated cord blood transplantation(UCBT) before the Engraftment, including unexplained fever higher than 38.3°CAunexplained erythematous skin rashAdiarrheaAhepatic dysfunction Anon-cardiogenic edemaApulmonary infiltrates and weight gain. Severe PES can be fatal, however there’s no criteria to define it. We retrospectively analyzed the incidence, risk factors, manifestations and clinical outcomes of PES in CBT recipients, who had been treated for hematologic malignancies. All patients received TBI(12GY)/Ara-c(8g/ m2)/CY(120mg/kg) without ATG or Flu(120mg/ m2)/Ara-c(8g/ m2)+BU(12.8mg/kg)+CY (120mg/kg) myeloablative conditioning. Methods From April 2010 to July 2011, 61 patients underwent UCBT at our transplantation center and 40 patients(65.6%) developed PES at a median of 7 d (range 5–13) post-transplant. We analyze 8 factors related to treatment-related mortality (TRM) within 180 days : occurrence timeAthe maximum temperatureAclinical symptomsAconcentration of CyclosporinAthe initial dose of MPAmethylprednisolone (MP) effective daysAdays till MP reduced and reoccurrence after symptoms under control. Univariate analysis identified early occurrence time( day +5 or +6 ) AMP effective days and clinical symptoms as significant risk factors for higher TRM. In a multivariate analysis, we found these three factors are independent and have no interactions. We retrospectively analyze all the patients who developed PES from April 2010 to December 2012. Results There were 94 cases and we scored them based on these three factors. The patient got one score for each factor if he/she got a fever on day 5-6 after UCBT or had more than two clinical symptoms or not under control after 7 days of MP. We added the three scores together and divide the patients into four groups according to the total score(zero for Group 1Aone score for Group 2Atwo score for Group 3Athree for Group 4). The number of patients for Group 1-4 was 32A32A18 and 12. There is a significant difference for the TRM within 180 days between Group 4(58%) and Group 1(18.7%)AGroup 2(22.2%) (P
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pre Engraftment Syndrome after myeloablative umbilical cord blood transplantation risk factors and how to stratify
Blood, 2013Co-Authors: Mao-jing Guan, Xingbing Wang, Liangquan Geng, Juan Tong, Changcheng Zheng, Baolin TangAbstract:Introduction Pre-Engraftment Syndrome (PES) is a group of symptoms occurred after hematopoietic stem cell transplantation especially unrelated cord blood transplantation(UCBT) before the Engraftment, including unexplained fever higher than 38.3°CAunexplained erythematous skin rashAdiarrheaAhepatic dysfunction Anon-cardiogenic edemaApulmonary infiltrates and weight gain. Severe PES can be fatal, however there’s no criteria to define it. We retrospectively analyzed the incidence, risk factors, manifestations and clinical outcomes of PES in CBT recipients, who had been treated for hematologic malignancies. All patients received TBI(12GY)/Ara-c(8g/ m2)/CY(120mg/kg) without ATG or Flu(120mg/ m2)/Ara-c(8g/ m2)+BU(12.8mg/kg)+CY (120mg/kg) myeloablative conditioning. Methods From April 2010 to July 2011, 61 patients underwent UCBT at our transplantation center and 40 patients(65.6%) developed PES at a median of 7 d (range 5–13) post-transplant. We analyze 8 factors related to treatment-related mortality (TRM) within 180 days : occurrence timeAthe maximum temperatureAclinical symptomsAconcentration of CyclosporinAthe initial dose of MPAmethylprednisolone (MP) effective daysAdays till MP reduced and reoccurrence after symptoms under control. Univariate analysis identified early occurrence time( day +5 or +6 ) AMP effective days and clinical symptoms as significant risk factors for higher TRM. In a multivariate analysis, we found these three factors are independent and have no interactions. We retrospectively analyze all the patients who developed PES from April 2010 to December 2012. Results There were 94 cases and we scored them based on these three factors. The patient got one score for each factor if he/she got a fever on day 5-6 after UCBT or had more than two clinical symptoms or not under control after 7 days of MP. We added the three scores together and divide the patients into four groups according to the total score(zero for Group 1Aone score for Group 2Atwo score for Group 3Athree for Group 4). The number of patients for Group 1-4 was 32A32A18 and 12. There is a significant difference for the TRM within 180 days between Group 4(58%) and Group 1(18.7%)AGroup 2(22.2%) (P<0.01). The TRM of Group 4 in one year is 66.7%, which is significantly higher than Group 1( 22.7%), Group 3(22.2%) (P<0.01), but shows less significant difference compared with TRM of group 2, which is 33%. The relapse rate of one year for each group from 1 to 4 was 9%A16.7%A5.5%A8.3%. The probability of one-year disease-free survival (DFS) was much higher in Group 1 (71.7%) and 3(72.2%) than Group 4(25%) (P<0.01). The difference was apparent as to the probability of one-year overall survival (OS) between Group 1 (74.8%) and 4(25%), the same is true whith Group 3 (71.3%) and 4(25%). The difference between Group 2(55.4%) and Group 4 was not clearly significant (P=0.06). Conclusions Recognizing and treating immediately severe PES will significantly reduce the TRM of UCBT. Our analyze confirmed that these three factors are crucial to define severe PES .We therefore put forward this ranking method to help to diagnosis and take effective treatment. Disclosures: No relevant conflicts of interest to declare.
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pre Engraftment Syndrome after unrelated donor umbilical cord blood transplantation in patients with hematologic malignancies
European Journal of Haematology, 2012Co-Authors: Xingbing Wang, Liangquan Geng, Kaiyang Ding, Lailing Li, Juan TongAbstract:Pre-Engraftment Syndrome (PES) after umbilical cord blood transplantation (CBT) remains poorly characterized, and the prognosis and appropriate management are unclear. Therefore, we retrospectively analyzed the incidence, risk factors, manifestations, and clinical outcomes of PES in CBT recipients, who had been treated for hematologic malignancies at our transplantation center. PES was defined as unexplained fever higher than 38.3°C that is not associated with documented infection and unresponsive to antimicrobial manipulations and/or unexplained erythematous skin rash occurring prior to neutrophil Engraftment. A total of 81 patients (median 18 yr, range 3–48) received either myeloablative (n = 72) or non-myeloablative (n = 9) conditioning. Neutrophil Engraftment was achieved in 69 of the 81 cases [86.2%, 95% confidence interval (CI) = 78.9–94.1%], and the median time to more than 0.5 × 109/L ANC was 19 d (range, 12–39). Fifty-one patients (63.0%) developed PES at a median of 7 d (range 3–15) post-transplant: 46 patients had both rash and unexplained fever; one patient had unexplained fever alone; and four patients had rash only. Forty-seven patients (92.2%) received IV methylprednisolone (MP) at a median dose of 1 mg/kg (range 0.4–3). All patients treated with MP responded as evidenced by fever resolution combined with resolution of rash. All patients with PES had high serum levels of C-reactive protein (CRP), which were significantly reduced after effective steroid treatment. Univariate analysis identified myeloablative conditioning and younger age as significant risk factors for developing PES. Cumulative incidence of grade II–IV acute graft-versus-host disease (aGVHD) in the PES+ and PES− groups was 51.5% (95% CI = 38.0–70.0%) and 17.0% (95% CI = 6.9–41.7%), respectively. In a multivariate analysis, we found significantly increased risk of grade II–IV aGVHD among PES patients (P = 0.041). However, PES was not associated with sustained donor Engraftment, the day to neutrophil recovery, chronic graft-versus-host disease, transplant-related mortality at day 180, and overall survival. Despite of the inherent limitations of this small retrospective study, PES seemed to be common after CBT and associated with high incidence of aGVHD.
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Pre‐Engraftment Syndrome after unrelated donor umbilical cord blood transplantation in patients with hematologic malignancies
European Journal of Haematology, 2011Co-Authors: Xingbing Wang, Liangquan Geng, Kaiyang Ding, Lailing Li, Juan TongAbstract:Pre-Engraftment Syndrome (PES) after umbilical cord blood transplantation (CBT) remains poorly characterized, and the prognosis and appropriate management are unclear. Therefore, we retrospectively analyzed the incidence, risk factors, manifestations, and clinical outcomes of PES in CBT recipients, who had been treated for hematologic malignancies at our transplantation center. PES was defined as unexplained fever higher than 38.3°C that is not associated with documented infection and unresponsive to antimicrobial manipulations and/or unexplained erythematous skin rash occurring prior to neutrophil Engraftment. A total of 81 patients (median 18 yr, range 3–48) received either myeloablative (n = 72) or non-myeloablative (n = 9) conditioning. Neutrophil Engraftment was achieved in 69 of the 81 cases [86.2%, 95% confidence interval (CI) = 78.9–94.1%], and the median time to more than 0.5 × 109/L ANC was 19 d (range, 12–39). Fifty-one patients (63.0%) developed PES at a median of 7 d (range 3–15) post-transplant: 46 patients had both rash and unexplained fever; one patient had unexplained fever alone; and four patients had rash only. Forty-seven patients (92.2%) received IV methylprednisolone (MP) at a median dose of 1 mg/kg (range 0.4–3). All patients treated with MP responded as evidenced by fever resolution combined with resolution of rash. All patients with PES had high serum levels of C-reactive protein (CRP), which were significantly reduced after effective steroid treatment. Univariate analysis identified myeloablative conditioning and younger age as significant risk factors for developing PES. Cumulative incidence of grade II–IV acute graft-versus-host disease (aGVHD) in the PES+ and PES− groups was 51.5% (95% CI = 38.0–70.0%) and 17.0% (95% CI = 6.9–41.7%), respectively. In a multivariate analysis, we found significantly increased risk of grade II–IV aGVHD among PES patients (P = 0.041). However, PES was not associated with sustained donor Engraftment, the day to neutrophil recovery, chronic graft-versus-host disease, transplant-related mortality at day 180, and overall survival. Despite of the inherent limitations of this small retrospective study, PES seemed to be common after CBT and associated with high incidence of aGVHD.
Robert J Soiffer - One of the best experts on this subject based on the ideXlab platform.
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syngeneic donor hematopoietic stem cell transplantation is associated with high rates of Engraftment Syndrome
Biology of Blood and Marrow Transplantation, 2011Co-Authors: John Koreth, Melinda Biernacki, Julie Aldridge, Edwin P Alyea, Philippe Armand, Corey Cutler, Vincent T Ho, Catherine J Wu, Joseph H Antin, Robert J SoifferAbstract:Engraftment Syndrome (ES), typically characterized by noninfectious fever, rash, and/or noncardiogenic pulmonary edema, is a complication of autologous and allogeneic hematopoietic stem cell transplantation (HSCT). There are no data on ES after syngeneic HSCT. We retrospectively analyzed syngeneic HSCT outcomes and determined ES incidence, risk factors, and prognostic impact. Thirty-two adult patients with a median age of 46 years (range: 22-60) underwent syngeneic HSCT at our institution between July 1986 and April 2009, primarily for hematologic malignancies (65% lymphoid-including 15% plasma cell; 31% myeloid). The median duration of follow-up was 6.1 years (range: 3.7 months to 18.1 years). Five-year progression-free and overall survival (PFS, OS) was 52% and 67%, respectively. Five-year overall cumulative incidence of relapse and nonrelapse mortality (NRM) was 37.6% and 10.2%, respectively; with increased relapse incidence of 76.3% in myeloid disease ( P = .002). Fifteen patients (47%) met diagnostic criteria for ES, 10 (67%) of whom received systemic steroids. Five-year PFS was 47% in patients with ES versus 56% in those without ( P = .37). Five-year OS was 63% with ES versus 71% without ( P = .80). Five-year cumulative incidence of NRM was 21% with ES versus 0% without ( P = .06). Five-year cumulative incidence of relapse was 32% with ES and 44% without ( P = .68). Older age ( P = .05) and possibly total body irradiation–based conditioning ( P = .09) were risk factors for developing ES. In multivariable Cox models only diagnosis (myeloid disease) impaired OS and PFS. In summary, we document a high incidence of ES after syngeneic HSCT. The trend of increased NRM after ES requires reevaluation in a larger syngeneic HSCT cohort.
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syngeneic donor hematopoietic stem cell transplantation is associated with high rates of Engraftment Syndrome
Blood, 2010Co-Authors: John Koreth, Melinda Biernacki, Julie Aldridge, Edwin P Alyea, Philippe Armand, Corey Cutler, Vincent T Ho, Catherine J Wu, Joseph H Antin, Robert J SoifferAbstract:Abstract 1323 Engraftment Syndrome (ES), typically characterized by non-infectious fever, rash and/or non-cardiogenic pulmonary edema, is a complication of autologous and allogeneic hematopoietic stem cell transplantation (HSCT). There is no data on ES after syngeneic HSCT. We retrospectively analyzed syngeneic HSCT outcomes and determined ES incidence, risk factors, and prognostic impact. 32 adult patients with a median age of 46 years (range, 22–60) underwent syngeneic HSCT at our institution between July 1986-April 2009, primarily for hematologic malignancies (31% myeloid, 66 % lymphoid-including 16% plasma cell). Syngeneic donor typing methods varied over the time-period of this report and included: serologic HLA Class I and II typing; confirmatory SSP molecular HLA Class I typing; molecular PCR-RFLP and SSP HLA Class II typing; and STR genotyping using ABI Profile Plus Kit Human Identity markers. Patient characteristics: 15 (47%) were male; 28 (88%) had high-risk disease; 18 (56%) received total-body irradiation (TBI) as a component of myeloablative conditioning; 16 (50%) received donor peripheral blood stem cell infusion; and 14 (41%), 10 (31%) and 9 (28%) had low-, intermediate- and high-risk HCT-comorbidity index score respectively. No graft-versus-host-disease prophylaxis, T-cell depletion, or pre-emptive or prophylactic donor lymphocyte infusion was utilized. The median duration of follow-up was 6.1 years (range, 3.7 months-18.1 years). 5-year progression-free and overall survival (PFS, OS) was 52% and 67% respectively. 5-year overall cumulative incidence of relapse and non-relapse mortality (NRM) was 37.6% and 10.2% respectively. 15 patients (47%) met diagnostic criteria for ES, 10 (67%) of whom received a brief course of systemic steroids with prompt clinical response in all except one patient (who died of respiratory failure). Patient age ≥50 years was a risk factor for developing ES (p=0.05). Median time to Engraftment was 12 days in patients with ES vs. 11.5 days in those without ES. 5-year PFS was 47% in patients with ES vs. 56% in those without (p=0.37). 5-year OS was 63% with ES vs. 71% without (p=0.8). 5-year cumulative incidence of relapse was 32% with ES and 44% without (p=0.68). 5-year cumulative incidence of NRM was 21% with ES vs. 0% without (p=0.06). In multivariable Cox-models only myeloid diagnosis (vs. lymphoid) impaired PFS and OS (HR 4.83, 95% CI 1.33–17.53, p=0.02; HR 8.47, 95% CI 1.73–41.58, p In summary, we document a high incidence of ES after syngeneic HSCT. While syngeneic ES did not impact HSCT survival outcomes, the trend of increased NRM with ES is concerning and needs re-evaluation in a larger cohort. Disclosures: No relevant conflicts of interest to declare.
Junya Kanda - One of the best experts on this subject based on the ideXlab platform.
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pre Engraftment Syndrome after myeloablative dual umbilical cord blood transplantation risk factors and response to treatment
Bone Marrow Transplantation, 2013Co-Authors: Junya Kanda, Leylagul Kaynar, Yoshinobu Kanda, Vinod K Prasad, Suhag Parikh, Tong Shen, David A Rizzieri, Gwynn D LongAbstract:Pre-Engraftment Syndrome after myeloablative dual umbilical cord blood transplantation: risk factors and response to treatment