Preengraftment syndrome after unrelated cord blood transplant is a strong predictor of acute and chronic graft-versus-host disease.

Pubmed ID: 19822310

Journal: Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation

Publication Date: Nov. 1, 2009

Affiliation: Pediatric Stem Cell Transplant Program, Vanderbilt University, Nashville, Tennessee 37232-2573, USA. Haydar.Frangoul@Vanderbilt.edu

MeSH Terms: Humans, Male, Female, Adolescent, Chronic Disease, Infant, Newborn, Child, Prospective Studies, Incidence, Acute Disease, Cord Blood Stem Cell Transplantation, Child, Preschool, Infant, Cytokines, Graft vs Host Disease, Transplantation Conditioning, Tissue Donors, Blood Cell Count, Edema, Fever, Immunosuppressive Agents, Syndrome

Grants: UL1 RR024975

Authors: Frangoul H, Wang L, Harrell FE, Ho R, Domm J

Cite As: Frangoul H, Wang L, Harrell FE Jr, Ho R, Domm J. Preengraftment syndrome after unrelated cord blood transplant is a strong predictor of acute and chronic graft-versus-host disease. Biol Blood Marrow Transplant 2009 Nov;15(11):1485-8. Epub 2009 Aug 25.

Studies:

Abstract

Preengraftment syndrome (PES) is a known complication following unrelated cord blood transplant (CBT) that has not been well characterized. We sought to determine the incidence and clinical outcome of PES among 326 patients <18 years of age who were prospectively enrolled on a multicenter CBT trial. All patients received a myeloablative (MA) transplant and a single cord blood unit (CBU). PES developed in 20% of the patients at a median of 10 days (range: 5-24). Patients receiving a CBU with a total nucleated cell (TNC) count of >5 x 10(7)/kg had significantly higher risk of developing PES (P = .02). There were significantly higher rates of grade II-V (P < .001), grade III-IV (P < .001) acute and chronic (P = .002) graft-versus-host disease (aGVHD, cGVHD) in those who developed PES. In a multivariate analysis, PES did not significantly affect overall survival (OS) (P = .38). We conclude that PES is common following CB transplant (CBT) and additional more intensive immune suppression might be considered to decrease the risk of developing aGVHD and cGVHD.