Chest radiographic features of engraftment syndrome

About the time of hematopoietic engraftment, patients undergoing autologous hematopoietic stem cell transplantation in the form of peripheral blood st em cell transplantation (PSCT) may develop an "engraftment syndrome" that i ncludes fever, skin rash, and capillary leak. This condition is usually sel f-limited, as opposed to other early complications of bone marrow transplan tation such as infection and drug reactions. This article describes the che st radiographic manifestations of engraftment syndrome. The medical records and chest radiographs of 50 consecutive breast cancer patients who underwe nt PSCT were retrospectively reviewed. Engraftment syndrome was diagnosed i f the expected clinical findings occurred at the time of engraftment of neu trophils and no other cause was identified. The chest radiographs were corr elated with the clinical course. Sixteen patients were found to have engraf tment syndrome (32%). Of these, eight had abnormal radiographs. Radiographi c findings consisted of pleural effusions and interstitial pulmonary edema. No patient progressed to adult respiratory distress syndrome. Interstitial pulmonary edema and pleural effusions were observed in association with en graftment syndrome from PSCT. Correlation of these findings with clinical h istory and neutrophil count is important so that engraftment syndrome can b e distinguished from other causes of fever.