Pre-Engraftment Syndrome Following Umbilical Cord Blood Transplantation Is a Strong Predictor of Acute Graft-Versus-Host Disease

Abstract 1267

Pre-engraftment syndrome (PES) has been described in patients receiving umbilical cord blood transplantation (CBT). However, PES remains poorly characterized, and the prognosis and appropriate management are unclear. Therefore, we retrospectively analyzed the incidence, risk factors, manifestations, and clinical outcome of PES in CBT recipients treated for hematological malignancies at our transplantation center.

A total of 60 patients (median 20 years, range 3–48) received either myeloablative (n=52) or reduced-intensity (n=8) conditioning. 28 patients received double unit grafts to augment engraftment. Cyclosporine-A and mycophenolate mofetil were used as GVHD prophylaxis, and all patients received post-transplant granulocyte colony-stimulating factor.

In this study, PES was defined as noninfectious fever (>38.3°C) and/or unexplained rash occurring before neutrophil engraftment. 38 patients (63.3%) fulfilled PES criteria: 33 with fever and 36 with rash. The median onset was 8 days (range 3–15) post-transplant (a median of 12 days before neutrophil recovery). 34 patients received IV methylprednisolone (MP) (0.5-2 mg/kg/d) with 27/34 (79.4%) having fever and/or rash resolution in <48 hours. Univariate analysis identified myeloablative conditioning and younger age as significant risk factors for developing PES. Use of TBI or ATG in conditioning regimen, the infused total nucleated cell dose, gender, weight, blood type mismatch, transplantation of UCB units and degree of donor-recipient HLA disparity were not significantly associated with the development of PES in our series. The cumulative incidence of sustained donor engraftment was 83.3%. Patients with PES had a higher incidence of developing grade II -IV acute GVHD, but PES was not associated with sustained donor engraftment, the day to neutrophil recovery and chronic GVHD. Overall survival did not significantly differ between patients with and without PES.

We conclude that PES is common following CB transplant (CBT), predicts for aGVHD, and responds promptly to corticosteroids.