Engraftment Syndrome after Autologous Stem Cell Transplantation: An Update Unifying the Definition and Management Approach

Abstract

Engraftment syndrome (ES) encompasses a continuum of periengraftment complications after autologous hematopoietic stem cell transplantation. ES may include noninfectious fever, skin rash, diarrhea, hepatic dysfunction, renal dysfunction, transient encephalopathy, and capillary leak features, such as noncardiogenic pulmonary infiltrates, hypoxia, and weight gain with no alternative etiologic basis other than engraftment. Given its pleiotropic clinical presentation, the transplant field has struggled to clearly define ES and related syndromes. Here, we present a comprehensive review of ES in all documented disease settings. Furthermore, we discuss the proposed risk factors, etiology, and clinical relevance of ES. Finally, our current approach to ES is included along with a proposed treatment algorithm for the management of this complication.

Keywords: Autologous graft-versus-host disease; Engraftment syndrome; Lymphoma; Multiple myeloma; POEMS.

Copyright © 2015 American Society for Blood and Marrow Transplantation. Published by Elsevier Inc. All rights reserved.

Figures

Figure 1. Engraftment syndrome encompasses a spectrum of autologous SCT-associated syndromes that vary in degrees of severity

PERDS, peri-engraftment respiratory distress syndrome; CLS, capillary leak syndrome; AGVHD, autologous graft versus host disease; GI, gastrointestinal.

Figure 2. Hypothetical mechanisms of engraftment syndrome

Proposed stages and severities of ES following ASCT are modeled. Predicted cytokine and leukocyte involvement is shown for each stage. Neutrophil and T cell engraftments are complete by days 14 and 56, respectively. N, neutrophil; DC, dendritic cell, Mac, macrophage; NK, NK cell; CD4, helper T cell; CD8, cytotoxic T cell; B, B cell; Treg, regulatory T cell; NE, normal epithelium; GVHD, graft versus host disease histology.

Figure 3. Our Management Approach to Engraftment Syndrome

IST; immune suppressive therapy.