High incidence of haemophagocytic syndrome following umbilical cord blood transplantation for adults
- 27 October 2009
- journal article
- Published by Wiley in British Journal of Haematology
- Vol. 147 (4), 543-553
- https://doi.org/10.1111/j.1365-2141.2009.07863.x
Abstract
Umbilical cord blood transplantation (CBT) is widely accepted, but one critical issue for adult patients is a low engraftment rate, of which one cause is haemophagocytic syndrome (HPS). We aimed to identify the contribution of HPS to engraftment failure after CBT, following preparative regimens containing fludarabine phosphate, in 119 patients (median age, 55 years; range; 17-69 years) with haematological diseases. Graft-versus-host disease prophylaxis comprised continuous infusion of a calcineurin inhibitor with or without mycophenolate mofetil. Of the 119 patients, 20 developed HPS within a median of 15 d (cumulative incidence; 16.8%) and 17 of them did so before engraftment. Donor-dominant chimaerism was confirmed in 16 of 18 evaluable patients with HPS. Despite aggressive interventions including corticosteroid, ciclosporin, high-dose immunoglobulin and/or etoposide, engraftment failed in 14 of 18 patients. Of these 14 patients, four received second rescue transplantation and all resulted in successful engraftment. Overall survival rates significantly differed between patients with and without HPS (15.0% vs. 35.4%; P < 0.01). Univariate and multivariate analysis identified having fewer infused CD34(+) cells as a significant risk factor for the development of HPS (P = 0.01 and 0.006, respectively). We concluded that engraftment failure closely correlated with HPS in our cohort, which negatively impacted overall survival after CBT.Keywords
This publication has 40 references indexed in Scilit:
- Encouraging Results of Low-Dose Etoposide in the Treatment of Early-Onset Hemophagocytic Syndrome Following Allogeneic Hematopoietic Stem Cell TransplantationInternational Journal of Hematology, 2007
- Umbilical cord blood transplantation after nonmyeloablative conditioning: impact on transplantation outcomes in 110 adults with hematologic diseaseBlood, 2007
- Successful engraftment by second cord blood transplantation with reduced-intensity conditioning after graft rejection due to hemophagocytic syndrome following initial CBTBone Marrow Transplantation, 2007
- Reduced dose of foscarnet as preemptive therapy for cytomegalovirus infection following reduced‐intensity cord blood transplantationTransplant Infectious Disease, 2007
- Double Unrelated Reduced-Intensity Umbilical Cord Blood Transplantation in AdultsTransplantation and Cellular Therapy, 2007
- Short-term methotrexate could reduce early immune reactions and improve outcomes in umbilical cord blood transplantation for adultsBone Marrow Transplantation, 2006
- Hyperacute GVHD and emergence of peripheral CD3+CD56+ T cells and activated natural killer cells are useful markers for early diagnosis of post-transplant hemophagocytic syndromeBone Marrow Transplantation, 2005
- Adult recipients of umbilical cord blood transplants after nonmyeloablative preparative regimensTransplantation and Cellular Therapy, 2004
- Successful Engraftment After Reduced-Intensity Umbilical Cord Blood Transplantation for Adult Patients with Advanced Hematological DiseasesClinical Cancer Research, 2004
- Rapid and complete donor chimerism in adult recipients of unrelated donor umbilical cord blood transplantation after reduced-intensity conditioningBlood, 2003