Favorable outcome to glucocorticoid therapy for engraftment syndrome in pediatric autologous hematopoietic cell transplant

Abstract

ES remains an important cause of morbidity and mortality in children undergoing auto-HCT. Glucocorticoid use in ES is an area of debate. We retrospectively analyzed single-institution experience from September 2000 through December 2012 to evaluate the use of glucocorticoids in auto-HCT patients. ES was defined by the occurrence of new onset of non-infectious fever plus diarrhea, rash, or pulmonary infiltrates 24-h before or within five days after neutrophil engraftment. Sixty-five pediatric patients (<21 yr) with different solid tumors underwent auto-HCTs in the study period. Fifteen patients (23%) fulfilled criteria for ES, of which 13 received methylprednisolone (2 mg/kg IV for 3-5 days). Clinical improvement occurred in all patients within 48 h without significant complications. In the non-ES group, 11 patients received glucocorticoid without significant complications as well. MEL-based regimens were found to be significant factor for ES (p < 0.05). Fever, edema, non-infectious diarrhea, and serum albumin concentration were statistically different between the two groups. Median hospital length of stay was higher in the ES group. Conclusion: ES is a common complication in children after auto-HCT and short-course glucocorticoid therapy is an effective and well-tolerated treatment, even in those who did not completely fulfill diagnostic criteria.