To analyse our experience of Engraftment Syndrome using a revised criteria.
166 patients underwent HSCT from Jan 2013 to Jan 2015. 41 had allogenic HSCT while 125 had an autologous HSCT.159 used peripheral blood, 6 umbilical cord and 1 bone marrow as stem cell source.86 had multiple myeloma,3 POEMS syndrome, 31 AML, 6 ALL, 9 Hodgkin's lymphoma, 10 NHL.The median age was 40 years (range 3.5 months to 65 years) and M: F ratio was 2.8:1.The daily records during the transplant period and follow up were analysed. Spitzer's criteria (2001) includes 3 major or 2 major +1 minor criteria within 96 hrs of engraftment. Major criteria are non-infectious fever, rash, hypoxemia, while minor criteria are weight gain, renal or hepatic dysfunction and transient encephalopathy. Maolino criteria (2003) requires non-infectious fever with either of rash, pulmonary infiltrate or diarrhoea from 24 hr before the first appearance of neutrophils to any time after it. We defined ES as clinical manifestations satisfying any 2 of the Spitzer's criteria or the Maolino's criteria from 24 hour before the first appearance of neutrophils up-to 7 days later.
20 patients had ES. Median age was 42(range 16-62yr).M: F ratio = 1.2:1. Incidence of ES was 12% (20/166), 14.4% (18/125) for autologous HSCT and 4.8% (2/41) for allogenic HSCT. In patients with ES, culture negative fever and skin rash were present in 80% each, weight gain in 90%, dyspnea, pulmonary infiltrates and hypoxemia in 55% each.Renal dysfunction and encephalopathy were found in 2 patients each. 15 patients satisfied Maolino criteria and Spitzer criteria separately.12 satisfied both simultaneously while 2 others didn't satisfy either. Diuretics alone were used in 6 patients, steroids alone in 5, both in 7. Median duration of steroid was 1 day (range0-4 days) and median time to resolution of symptoms was 24 hours. None had mortality. There was no statistically significant difference in supportive care between ES versus non ES patients.Female sex was significantly associated with the risk of ES on multivariate analysis.
The modified diagnostic criteria improves yield for Engraftment syndrome, but needs further validation in larger studies.
Clinical trial identification
All authors have declared no conflicts of interest.