ES is increasingly recognized as an important complication of autologous SCT. There is no consensus over diagnostic criteria (leading to variations in reported incidence from 7 to 55%) nor over risk factors. In order to better characterize this syndrome and its potential severity, we reviewed 380 consecutive autologous SCT (in 304 patients [pts]) performed in our center from 1/2006 to 8/2012.

Methods

During this period ES was diagnosed according to the Maiolino criteria (MC): non infectious fever beginning 24h pre-engraftment + pulmonary infiltrates or rash or diarrhea. We retrospectively reviewed all cases according to the Spitzer criteria (SC): 3 major criteria within 96h of engraftment (non infectious fever, rash, pulmonary infiltrates) or 2 major + 2 minor criteria (hepatic and renal disfunction, weight gain, encephalopathy). The following risk factors for ES were evaluated: sex, underlying disease, mobilization regimen (G-CSF with or without chemotherapy), conditioning regimen, number of reinfused CD34+ cells/kg, cryopreservation duration, time to engraftment and bacteremia rate. The following outcomes were analyzed: days on antibiotics, number of platelet transfusions, in-hospital days, and transplant related mortality (TRM).

Results

ES was diagnosed in 29 SCT (8%) in 27 pts (2 tandem SCT had ES in both) by MC. Only 8 of these fullfilled the SC. Most cases (83%) required corticosteroids and improved; 1 death was attributed to ES. By multivariate analysis the single risk factor for ES was a diagnosis of non Hodgkin’s lymphoma as opposed to Hodgkin’s (15% vs 3.7%, p=0.04); none of the remaining risk factors was statistically significant. Pts with ES spent more days on antibiotics (median 12 vs 10, p=0.008) and in the hospital (23 vs 19, p<0.000) and there was a trend to a higher TRM at d+30 (3.7 vs 1.3%) and d+100 (7.4 vs 4.2%).

Conclusions

We were able to confirm in our series that ES prolongs antibiotic duration and hospitalization and may increase the risk of death. Although ES is a complex entity with a difficult diagnosis, its prompt recognition is critical, as timely institution of corticosteroids diminishes the risk of multiorgan failure, avoids unnecessary use of antimicrobials, and reduces hospital days and costs. The SC are more stringent but too insensitive. We believe that, until prospective studies validate clearer diagnostic recommendations, transplant teams are best served by the MC.

Disclosures:

No relevant conflicts of interest to declare.

Topics:
adrenal corticosteroids, antibiotics, antimicrobials, autologous stem cell transplant, bacteremia, brachial plexus neuritis, chemotherapy regimen, cryopreservation, diarrhea, encephalopathy

Author notes

*

Asterisk with author names denotes non-ASH members.

© 2013 by The American Society of Hematology
2013
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