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

Frangoul H, Wang L, Harrell FE, Ho R, Domm J
Biol Blood Marrow Transplant. 2009 15 (11): 1485-8

PMID: 19822310 · DOI:10.1016/j.bbmt.2009.07.001

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.

MeSH Terms (22)

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

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