Abstract
Autologous hematopoietic stem cell transplantation (HSCT) is currently being evaluated as a therapy for patients with progressive multiple sclerosis (MS) at risk of debilitating neurological impairment. While preliminary results from a few studies have been reported, little is known about toxicities or outcome of HSCT for MS. We report a relatively frequent triad of non-infectious fever, rash and fatigue or lassitude that may also be associated with pruritis, pulmonary symptoms, and eosinophilia and frequently occurs around engraftment. This syndrome occurred in 26% of our series of patients (5/19) undergoing HSCT for multiple sclerosis. The engraftment syndrome is usually self-limited but may require intervention with systemic corticosteroids.
Bone Marrow Transplantation (2002) 29, 81–85. doi:10.1038/sj.bmt.1703324
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 12 print issues and online access
$259.00 per year
only $21.58 per issue
Buy this article
- Purchase on Springer Link
- Instant access to full article PDF
Prices may be subject to local taxes which are calculated during checkout
Similar content being viewed by others
References
Paty DW, Li DK UBC MS/MRI Study Group IFNB Multiple Sclerosis Study Group. Interferon beta-1b is effective in relapsing-remitting multiple sclerosis. II. MRI analysis results of a multicenter, randomized, double-blind, placebo-controlled trial Neurology 1993 43: 662 667
The IFNB Multiple Sclerosis Study Group University of British Columbia MS/MRI Analysis Group. Interferon (beta)-1b in the treatment of multiple sclerosis: final outcome of the randomized controlled trial Neurology 1995 45: 1277 1285
PRISMS (Prevention of Relapses and Disability by Interferon (beta)-1a Subcutaneously in Multiple Sclerosis) Study Group. Randomised double-blind placebo-controlled study of interferon (beta)-1a in relapsing/remitting multiple sclerosis. (Published erratum, Lancet 1999; 353: 678) Lancet 1998 352: 1498 1504
European Study Group on Interferon (beta)-1b in Secondary Progressive MS. Placebo-controlled multicentre randomised trial of interferon (beta)-1b in treatment of secondary progressive multiple sclerosis Lancet 1998 352: 1491 1497
The IFNB Multiple Sclerosis Study Group. Interferon beta-1b is effective in relapsing-remitting multiple sclerosis. I. Clinical results of a multicenter, randomized, double-blind, placebo-controlled trial Neurology 1993 43: 655 661
Johnson KP, Brooks BR, Cohen JA et al. Copolymer 1 reduces relapse rate and improves disability in relapsing-remitting multiple sclerosis: results of a phase III multicenter, double-blind placebo-controlled trial Neurology 1995 45: 1268 1276
Johnson KP, Brooks BR, Cohen JA et al. Extended use of glatiramer acetate (Copaxone) is well tolerated and maintains its clinical effect on multiple sclerosis relapse rate and degree of disability Neurology 1998 50: 701 708
Millefiorini E, Gasperini C, Pozzilli C et al. Randomized placebo-controlled trial of mitoxantrone in relapsing-remitting multiple sclerosis: 24-month clinical and MRI outcome J Neurol 1997 244: 153 159
Edan G, Miller D, Clanet M et al. Therapeutic effect of mitoxantrone combined with methylprednisolone in multiple sclerosis: a randomised multicentre study of active disease using MRI and clinical criteria J Neurol Neurosurg Psychiat 1997 62: 112 118
Sadovnick AD, Eisen K, Ebers GC, Paty DW . Cause of death in patients attending multiple sclerosis clinics Neurology 1991 41: 1193 1196
Burt RK, Burns W, Hess A . Bone marrow transplantation for multiple sclerosis Bone Marrow Transplant 1995 16: 1 6
Burt RK, Padilla J, Dal Canto MC, Miller SD . Viral hyperinfection of the central nervous system and high mortality after hematopoietic stem cell transplantation for treatment of Theiler's murine encephalomyelitis virus-induced demyelinating disease Blood 1999 94: 2915 2922
van Bekkum DW . Stem cell transplantation in experimental models of autoimmune disease J Clin Immunol 2000 20: 10 16
Karussis D, Vourka-Karussis U, Mizrachi-Koll R, Abramsky O . Acute/relapsing experimental autoimmune encephalomyelitis: induction of long lasting, antigen-specific tolerance by syngeneic bone marrow transplantation Multiple Sclerosis 1999 5: 17 21
Burt RK, Padilla J, Begolka WS et al. Effect of disease stage on clinical outcome after syngeneic bone marrow transplantation for relapsing experimental autoimmune encephalomyelitis Blood 1998 91: 2609 2616
Van Gelder M, van Bekkum DW . Effective treatment of relapsing experimental autoimmune encephalomyelitis with pseudoautologous bone marrow transplantation Bone Marrow Transplant 1996 18: 1029 1034
Karussis DM, Vourka-Karussis U, Lehmann D et al. Prevention and reversal of adoptively transferred, chronic relapsing experimental autoimmune encephalomyelitis with a single high dose cytoreductive treatment followed by syngeneic bone marrow transplantation J Clin Invest 1993 92: 765 772
van Gelder M, Kinwel-Bohre EP, van Bekkum DW . Treatment of experimental allergic encephalomyelitis in rats with total body irradiation and syngeneic BMT Bone Marrow Transplant 1993 11: 233 241
van Gelder M, van Bekkum DW . Treatment of relapsing experimental autoimmune encephalomyelitis in rats with allogeneic bone marrow transplantation from a resistant strain Bone Marrow Transplant 1995 16: 343 351
Burt RK, Burns W, Ruvolo P et al. Syngeneic bone marrow transplantation eliminates V beta 8.2 T lymphocytes from the spinal cord of Lewis rats with experimental allergic encephalomyelitis J Neurosci Res 1995 41: 526 531
Fassas A, Anagnostopoulos A, Kazis A et al. Peripheral blood stem cell transplantation in the treatment of progressive multiple sclerosis: first results of a pilot study Bone Marrow Transplant 1997 20: 631 638
Burt RK, Traynor AE, Cohen B et al. T cell-depleted autologous hematopoietic stem cell transplantation for multiple sclerosis: report on the first three patients Bone MarrowTransplant 1998 21: 537 541
Fassas A, Anagnostopoulos A, Kazis A et al. Autologous stem cell transplantation in progressive multiple sclerosis – an interim analysis of efficacy J Clin Immunol 2000 20: 24 30
Nash RA, Kraft GH, Bowen JD et al. Treatment of severe multiple sclerosis (MS) with high-dose immunosuppressive therapy (HDIT) and autologous stem cell transplantation (SCT) Blood 2000 96: (Suppl. 1) 842 (Abstr. 3640)
Openshaw H, Lund BT, Kashyap A et al. Peripheral blood stem cell transplantation in multiple sclerosis with busulfan and cyclophosphamide conditioning: report of toxicity and immunological monitoring Biol Blood Marrow Transplant 2000 6: 563 575
Carreras E, Saiz A, Graus F et al. Autologous CD34+ selected hematopoietic stem cell transplantation (CD34+/HSCT) for multiple sclerosis: update of a single center experience in 10 patients Biol Blood Marrow Transplant 2001 7: 69 (Abstr.)
Mandalfino P, Rice G, Smith A et al. Bone marrow transplantation in multiple sclerosis J Neurol 2000 247: 691 695
Kozak T, Havrdova E, Pit'ha J et al. High-dose immunosuppressive therapy with PBPC support in the treatment of poor risk multiple sclerosis Bone Marrow Transplant 2000 25: 525 531
Waxman SG, Geschwind N . Major morbidity related to hyperthermia in multiple sclerosis Ann Neurol 1983 13: 348
Kazis A, Vlaikidis N, Xafenias D et al. Fever and evoked potentials in multiple sclerosis J Neurol 1982 227: 1 10
Edenfield WJ, Moores LK, Goodwin G, Lee N . An engraftment syndrome in autologous stem cell transplantation related to mononuclear cell dose Bone Marrow Transplant 2000 25: 405 409
Kawano C, Muroi K, Kuribara R et al. Engraftment syndrome after autologous peripheral blood stem cell transplantation with high numbers of peripheral blood stem cells followed by granulocyte colony-stimulating factor administration Bone Marrow Transplant 2000 25: 228 229
de Arriba F, Corral J, Ayala F et al. Autoaggression syndrome resembling acute graft-versus-host disease grade IV after autologous peripheral blood stem cell transplantation for breast cancer Bone Marrow Transplant 1999 23: 621 624
Ravoet C, Feremans W, Husson B et al. Clinical evidence for an engraftment syndrome associated with early and steep neutrophil recovery after autologous blood stem cell transplantation Bone Marrow Transplant 1996 18: 943 947
Lee CK, Gingrich RD, Hohl RJ, Ajram KA . Engraftment syndrome in autologous bone marrow and peripheral stem cell transplantation Bone Marrow Transplant 1995 16: 175 182
Spitzer TR . Engraftment syndrome following hematopoietic stem cell transplantation Bone Marrow Transplant 2001 21: 893 898
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Oyama, Y., Cohen, B., Traynor, A. et al. Engraftment syndrome: a common cause for rash and fever following autologous hematopoietic stem cell transplantation for multiple sclerosis. Bone Marrow Transplant 29, 81–85 (2002). https://doi.org/10.1038/sj.bmt.1703324
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1038/sj.bmt.1703324
Keywords
This article is cited by
-
Prior anti-PD-1 therapy as a risk factor for life-threatening peri-engraftment respiratory distress syndrome in patients undergoing autologous stem cell transplantation
Bone Marrow Transplantation (2021)
-
The induction strategies administered in the treatment of multiple myeloma exhibit a deleterious effect on the endothelium
Bone Marrow Transplantation (2020)
-
Dermatologic Conditions of the Early Post-Transplant Period in Hematopoietic Stem Cell Transplant Recipients
American Journal of Clinical Dermatology (2019)
-
Innovative strategies minimize engraftment syndrome in multiple myeloma patients with novel induction therapy following autologous hematopoietic stem cell transplantation
Bone Marrow Transplantation (2018)
-
Engraftment syndrome: double-edged sword of hematopoietic cell transplants
Bone Marrow Transplantation (2015)