Divergent effects of novel immunomodulatory agents and cyclophosphamide on the risk of engraftment syndrome after autologous peripheral blood stem cell transplantation for multiple myeloma.
Engraftment syndrome (ES) is an increasingly observed and occasionally fatal complication after autologous peripheral blood stem cell transplantation (PBSCT). In this study, we demonstrate that the incidence of ES is significantly increased in patients undergoing autologous PBSCT for multiple myeloma in comparison to patients with non-Hodgkin lymphoma or Hodgkin lymphoma. Multivariate analysis revealed that age > 60 (hazard ratio [HR], 1.71; 95% confidence interval [CI], 1.12 to 2.62; P = .013) and transplantation for multiple myeloma (HR, 2.80; 95% CI, 1.60 to 4.90; P = .0003) were associated with an increased risk of this complication. When stratified for myeloma patients only, age > 60 (HR, 1.80; 95% CI, 1.13 to 2.87; P = .013) and prior treatment with both lenalidomide and bortezomib (HR, 1.83; 95% CI, 1.11 to 3.04; P = .0001) were associated with an increased incidence of ES. Conversely, lack of exposure to cyclophosphamide from either chemomobilization or as a component of the pretransplantation therapeutic regimen increased the risk of this complication (HR, 3.05; 95% CI, 1.91 to 4.87; P <.0001). These studies demonstrate that the pretransplantation exposure of multiple myeloma patients to novel immunomodulatory agents and cyclophosphamide significantly affects the subsequent risk of developing ES.
['Cornell|Robert Frank|RF|', 'Hari|Parameswaran|P|', 'Zhang|Mei-Jie|MJ|', 'Zhong|Xiabao|X|', 'Thompson|Jonathan|J|', 'Fenske|Timothy S|TS|', 'Horowitz|Mary M|MM|', 'Komorowski|Richard|R|', 'Palmer|Jeanne|J|', 'Pasquini|Marcelo C|MC|', 'Rizzo|J Douglas|JD|', 'Saber|Wael|W|', 'Thomas|Mathew|M|', 'Drobyski|William R|WR|']
D000293:Adolescent D000328:Adult D000368:Aged D000369:Aged, 80 and over D015331:Cohort Studies D003520:Cyclophosphamide D005260:Female D006085:Graft Survival D006801:Humans D007155:Immunologic Factors D008297:Male D008875:Middle Aged D009101:Multiple Myeloma D036102:Peripheral Blood Stem Cell Transplantation D012189:Retrospective Studies D014182:Transplantation, Autologous D055815:Young Adult
Engraftment syndrome Multiple myeloma Autologous graft-versus-host disease Autologous peripheral stem cell transplantation