Engraftment Syndrome

#med #disease #onc

Presentation :

Spitzer's Criteria: Within 96h of engraftment (neutrophils >500 for 2+ consecutive days), must have: all 3 major criteria OR 2 major + 1 minor criteria
- Major Criteria:
  - Temperature of >38.3 °C with no identifiable infectious etiology.
  - Erythrodermatous rash involving more than 25% of body surface area and not attributable to medication
  - Noncardiogenic pulmonary edema, manifested by diffuse pulmonary infiltrates consistent with this diagnosis, and hypoxia.
- Minor Criteria:
  - Hepatic dysfunction with either total bilirubin >2 mg/dlor transaminase levels >two times normal
  - Renal insufficiency (serum creatinine of >two times baseline)
  - Weight gain >2.5% of baseline body weight.
  - Transient encephalopathy unexplainable by other causes.
Maiolino’s criteria: Anytime from 24h prior to engraftment or any time thereafter must have: Noninfectious fever AND one of the following:
- Rash
- Pulmonary infiltrates
- Diarrhea (at least two episodes of liquid BM per day without any microbiological evidence of infection)

Thought related to the release of pro-inflammatory cytokines during neutrophil recovery after transplantation (hence the time proximity to engraftment)

Supportive care including: antipyretics, O2, topical therapy for rash, and diuretics can resolve ES in ≥20% of patients
Generally very corticosteroid-responsive. Methylprednisolone at a starting dose of 1 mg/kg/day is usually sufficient