Prophylactic corticosteroid use prevents engraftment syndrome in patients after autologous stem cell transplantation

Abstract

Engraftment syndrome (ES) following autologous stem cell transplantation (ASCT) at the time of neutrophil recovery may comprise fever, rash, pulmonary edema, or diarrhea. Usually, ES is easily manageable using corticosteroids but may prolong hospitalization. In two consecutive cohorts of subsequent patients with myeloma, lymphomas, and testicular/germ cell cancer, we assessed the benefit of corticosteroid use to prevent incidence and severity of ES following ASCT. Whereas Cohort A (82 patients) received no prophylactic corticosteroids, corticosteroids (4 mg dexamethasone oral daily) were started in Cohort B (60 patients) at day +9 until day +13 following ASCT. Steroid prophylaxis significantly reduced the incidence of ES (6/60; 10% vs. 33/82; 40%; p < 0.001). Hospitalization duration was longer in patients with ES than in patients without ES within both cohorts (in Cohort A: p = 0.007; and B: p = 0.011), but did not differ significantly between cohorts A and B. Finally, in Cohort A, there was a trend to an inferior 2‐year overall survival rate in patients without ES compared to patients with ES (p = 0.067), but definite conclusions are not yet allowed. Our results suggest that corticosteroid prophylaxis from days +9 to +13 following ASCT significantly reduces the risk of ES and shortens hospitalization duration.

Correlation of Peripheral Chimeric Antigen Receptor T-cell (CAR-T Cell) mRNA Expression Levels with Toxicities and Outcomes in Patients with Diffuse Large B-cell Lymphoma

“…Although our cohort is limited in size and follow-up duration, the findings seem to be comparable to those obtained for larger series of CAR-T cell recipients [ 4 , 5 , 6 , 7 , 8 , 14 , 15 , 24 , 25 , 26 ]. However, it should be noted that we were not able to investigate CD19 expressions in the lymphoma tissues at the time of relapse.…”

Comparison of Melphalan Combined with Treosulfan or Busulfan as High-Dose Chemotherapy before Autologous Stem Cell Transplantation in AML

“…Laboratory findings showed increased liver enzymes in most patients in both cohorts (BuMel: n = 16/16; 100%; TreoMel: n = 18/20; 90%; p = 0.999). Finally, rates of engraftment syndrome [ 28 ] at the time of neutrophil engraftment were similar in both treatment groups, occurring in five BuMel patients (31%) and in four TreoMel patients (20%; p = 0.47).…”

A desquamating rash in a pediatric patient – A clinicopathological challenge

“…Patients with respiratory failure may need temporary mechanical support. Prophylactic use of corticosteroids in patients undergoing autologous stem cell transplants has been shown to reduce the risk of ES and shorten the hospital stay and therefore warrants further investigation 11 …”