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Pulmonary manifestations of the pre-engraftment syndrome after umbilical cord blood transplantation

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Abstract

Pre-engraftment syndrome (PES) is a condition occurring after umbilical cord blood transplantation (UCBT) characterized by fever and erythematous skin rash prior to neutrophil engraftment. We sought to determine the incidence and characterize the pulmonary manifestations of PES. A retrospective review of patients who underwent UCBT at the University of Kansas Medical Center over a 5-year period was performed. Data collected included patient baseline characteristics, presence of PES, pulmonary findings, treatments, and survival. Forty-four patients underwent UCBT with 22 of those patients developing PES. Full-intensity myeloablative conditioning regimen was found to be a risk factor for development of PES. Of those 22 patients, 13 had resting hypoxemia. The most common radiographic findings included diffuse ground glass opacities with pleural effusions. Fifteen patients with PES received corticosteroids, of which 12 had improvement in fevers and rash. These patients had a trend toward worse mortality than those not receiving corticosteroids. There was a nonsignificant trend toward worse survival in patients with PES and hypoxemia compared to those without hypoxemia. PES is a common complication following cord blood transplantation, with hypoxemia being present in over half of patients with PES. Hypoxemia with PES and treatment with corticosteroids may portend a worse prognosis.

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Acknowledgments

We thank Omar S. Aljitawi as a recipient of a research career award granted by the Office of Scholarly Academic Research and Mentoring (OSARM) at the home institution. We would also like to thank Shaun DeJarnette for his help with the data collection.

Financial disclosure statement

None of the authors have any financial interests related to the subject matter of this manuscript. No funding was sought for or received in the production of this manuscript.

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Authors and Affiliations

  1. Division of Pulmonary and Critical Care Medicine, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 66160, USA

    Kyle R. Brownback & Steven Q. Simpson

  2. Division of Hematology and Oncology, University of Kansas Medical Center, Kansas City, KS, USA

    Joseph P. McGuirk, Tara L. Lin, Sunil Abhyankar, Siddhartha Ganguly & Omar S. Aljitawi

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  1. Kyle R. Brownback
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Correspondence to Kyle R. Brownback.

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Brownback, K.R., Simpson, S.Q., McGuirk, J.P. et al. Pulmonary manifestations of the pre-engraftment syndrome after umbilical cord blood transplantation. Ann Hematol 93, 847–854 (2014). https://doi.org/10.1007/s00277-013-1981-0

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  • DOI: https://doi.org/10.1007/s00277-013-1981-0

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