Cyclophosphamide and prednisone induction followed by cyclophosphamide mobilization effectively decreases the incidence of engraftment syndrome in patients with POEMS syndrome who undergo stem cell transplantation

Abstract

High‐dose chemotherapy with autologous stem cell transplantation (ASCT) can achieve excellent clinical responses in patients with POEMS syndrome (Jimenez Zepeda et al., Blood 2010;116:2403; Gertz et al., Am J Hematol 2005;79:319–328; Gherardi et al., Ann Neurol 1994;35:501–505; Gattinoni et al., Nat Rev Immunol 2006;6:383–393; Salem et al., J Immunol 2009;182:2030–2040; Salem et al., Cancer Immunol Immunother 2010;59:341–353; Salem et al., Cell Immunol 2010;261:134–143). However, High‐dose melphalan with ASCT should be considered carefully due to its treatment‐related morbidity (Vuckovic et al., Blood 2003;101:2314–2317), especially in patients with poor performance status owing to polyneuropathy and multiorgan involvement, such as cardiac, respiratory, and renal failure. Significant increases in the concentration of circulating macrophage colony‐stimulating factor, erythropoietin, IL‐6, and TNF‐α, reach near maximal values at approximately day +12, predating neutrophil engraftment, and clinically manifest with fever, rash and edema (Dispenzieri et al., Eur J Haematol 2008;80:397–406). Depending on the definition used, ∼50% of patients satisfied criteria for engraftment syndrome (ES) (Vuckovic et al., Blood 2003;101:2314–2317). ES occurs in 27–47% of patients who undergo ASCT; mortality rate is reported from 8% to 18% (Gattinoni et al., Nat Rev Immunol 2006;6:383–393; Vuckovic et al., Blood 2003;101:2314–2317). We have therefore reviewed our experience with ASCT in patients with POEMS syndrome who were treated with cyclophosphamide and prednisone as induction therapy followed by cyclophosphamide mobilization with an emphasis on treatment‐related morbidity and frequency of ES. Our study confirms that ASCT is a feasible and efficacious treatment for patients with POEMS syndrome. In addition, the use of CP followed by cyclophosphamide mobilization decreases the incidence of PES leading to less morbidity and mortality rates. Am. J. Hematol. 2011. © 2011 Wiley‐Liss, Inc.

PBSC mobilization in newly diagnosed patients with POEMS syndrome: outcomes and prognostic factors

“…It is reported that combination of CY and prednisone is an effective treatment regimen for patients with POEMS syndrome. 1 In addition, Jimenez-Zepeda et al 18 reported that short-term induction therapy of CY and prednisone before transplantation could significantly decrease the incidence of engraftment syndrome and reduce transplant-related mortality. Therefore, pretreatment with high dose of CY might decrease the level of pro-inflammatory cytokines, relieve disease activity and reduce G-CSF-related adverse effects, which might improve the efficacy and safety of mobilization.…”

Engraftment Syndrome: An Updated Review

“…Several recent studies on PES have come to the following conclusions: (1) common occurrence after UCBT, (2) development before neutrophil recovery, (3) associations with: cyclosporine in GVHD prophylaxis and total body irradiation in conditioning therapy, (4) enhancement of engraftment without significant morbidity as well as early achievement of complete donor chimerism, and (5) controversial association with development of acute GVHD [20,[36][37][38]. -Skin rash -Pulmonary infiltrates -Diarrhea commencing 24 hours before or at any time after the first appearance of neutrophils (1) GVHD prophylaxis using methotrexate in UCBT, (2) use of cyclophosphamide and prednisolone in induction followed by cyclophosphamide mobilization in patients with POEM syndrome, (3) use of donor lymphocyte infusions in relapsed CML after allogeneic HSCT, and (4) steroid prophylaxis significantly decreases the risk of ES following autologous HSCT and is associated with shortened hospitalization without increasing the risk of infection [42][43][44][45].…”

Long-term outcomes after autologous stem cell transplantation for patients with POEMS syndrome (osteosclerotic myeloma): a single-center experience

“…2 There have been multiple reports of high-dose chemotherapy with peripheral blood stem cell transplantation in patients with POEMS, but most studies are small and long-term outcomes are not well delineated. [3][4][5][6][7][8][9][10][11][12][13] Since 1999, we have expanded our experience with the use of autologous stem cell transplantation (ASCT) in patients with POEMS syndrome. In this article, we report the long-term outcomes of our cohort of POEMS patients treated with ASCT with an emphasis on identifying factors that were significantly associated with a risk of progression or relapse of POEMS syndrome after peripheral blood stem cell transplantation.…”