Engraftment Syndrome

Epidemiology

  • More common with auto-SCT than allo-SCT
  • Occurs in 7-9% of SCT’s
  • Occurs during neutrophil engraftment after SCT
  • Prevention: shielding the lung during TBI may prevent the pulmonary aspect of engraftment syndrome in some cases
  • Associated with poor long-term survival in breast cancer-related cases

Physiology

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Diagnostic Criteria

Major Criteria

  • Fever >38.8 with no identifiable infectious etiology
  • Erthrodermatous skin rash involving >25% of BSA and not attributable to a medication
  • Non-cardiogenic pulmonary edema: diffuse pulmonary infiltrates + hypoxemia

Minor Criteria

  • Hepatic dysfunction: TBili >2 mg/dL or transaminases >2x normal
  • AKI: CR >2x normal
  • Weight gain: >2.5% of baseline body weight
  • Transient encephalopathy unexplained by other causes

Clinical

  • As above
  • Pleural effusions: may occur

Treatment

  • Steroid-responsive

References

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