CLINICAL-EVIDENCE FOR AN ENGRAFTMENT SYNDROME-ASSOCIATED WITH EARLY AND STEEP NEUTROPHIL RECOVERY AFTER AUTOLOGOUS BLOOD STEM-CELL TRANSPLANTATION

Seventy autologous peripheral blood stem cell transplants (APBSCT) per formed in 61 cancer patients were retrospectively analyzed. Patients w ere heterogenous with regard to malignancy, conditioning regimens and use of growth factors after transplantation. Six patients developed a non-infectious fever, fluid retention and pulmonary interstitial infil trates during the early phase of neutrophil recovery, Diarrhea was obs erved in four of these patients and cutaneous rash in three. The clini cal condition improved spontaneously in one patient, and within 48 h a fter steroid therapy in four, One patient died from multiple organ fai lure, Age, sex (all patients were female; P = 0.07), and time to plate let recovery did not distinguish the six courses complicated by the hy pothetical engraftment syndrome (ES) from the other 64 courses taken a s controls, However, neutrophil recovery >0.5 x 10(9)/l occurred earli er (P = 0.01), and the neutrophil count increment during the early pha se of recovery was steeper in ES patients (P = 0.003). ES was also ass ociated with infusion of a high number of CD34(+) progenitors (P = 0.0 3) and conditioning with busulfan (P = 0.03), Although all ES patients received G-CSF after transplantation, an association of ES with G-CSF use could not be demonstrated, possibly because of the small number o f courses not supported by G-CSF. However, in one patient, ES did not recur after a second transplant unsupported by growth factors. Our stu dy supports the idea of an engraftment syndrome associated with an ear ly and steep neutrophil recovery after APBSCT.