Engraftment syndrome is an inflammatory disorder that usually occurs within the first 2 weeks after stem cell transplantation.

CLINICAL MANIFESTATIONS

Clinical manifestations may be associated with high fevers, generalized erythrodermatous rash, and third-spacing (explaining peripheral and noncardiogenic pulmonary edema). There may be cough, dyspnea, hypoxemia, multilobar pulmonary infiltrates, or other nonspecific findings.

DIAGNOSIS

Diagnosis is one of exclusion. There is no test for it, but tests that may be undertaken to rule out alternative etiologies include cultures, skin biopsy, and bronchoalveolar lavage.

ETIOLOGY

Etiology is poorly understood. In general, it is thought to reflect cytokine production due to immune dysregulation in the context of neutrophil recovery. The polymorphonuclear leukocytes (PMN) and lymphocytes are thought to be activated and contribute to the injury through further production of inflammatory mediators.

DIFFERENTIAL DIAGNOSIS

• Hyperacute graft-versus-host disease (GVHD) or traditional GVHD.

• Infection: Patients should always be treated presumptively for infection while diagnostic studies and cultures are being carried out.

• Transfusion-associated lung injury (TRALI). This entity typically occurs proximate to a transfusion and is thought to be due to preformed antiHLA antibodies in the transfused product.

• Drug reaction.

TREATMENT

Modest dose corticosteroids – for example, 40 mg solumedrol IVB daily followed by a taper if there is a response.