Recently Diagnosed or Relapsed? Stop Looking For a Miracle Cure, and Use Evidence-Based Therapies To Enhance Your Treatment and Prolong Your Remission
Multiple Myeloma an incurable disease, but I have spent the last 25 years in remission using a blend of conventional oncology and evidence-based nutrition, supplementation, and lifestyle therapies from peer-reviewed studies that your oncologist probably hasn't told you about.
Click the orange button to the right to learn more about what you can start doing today.
- You are here:
- Home »
- Blog »
- Multiple Myeloma »
- Engraftment Syndrome in Multiple Myeloma
Engraftment Syndrome in Multiple Myeloma
Engraftment syndrome in multiple myeloma is a fairly common symptom of autologous stem cell transplantation. Sadly, oncology refers to ES by several different names (see below) and therefore tracking ES is difficult.
“Studies have reported the incidence of ES in autologous stem cell transplant recipients to range from 7% to 48%.”
I am a long-term MM survivor. I have been researching and writing about multiple myeloma since the launch of PeopleBeatingCancer in 2004. When researching engraftment syndrome in multiple myeloma I was surprised to find little information about this common side effects of ASCT.
Email me at David.PeopleBeatingCancer@gmail.com with questions about autologous stem cell transplantation.
David Emerson
- MM Survivor
- MM Cancer Coach
- Director PeopleBeatingCancer
Engraftment syndrome following Hematopoietic stem cell transplantation: a systematic approach toward diagnosis and management
Engraftment syndrome (ES) is a non-infectious complication seen both in autologous and allogeneic hematopoietic stem cell transplants and is characterized by the presence of non-infectious fever, diarrhea, skin rash, pulmonary infiltration, pulmonary edema, and deranged renal and liver function tests…
Engraftment syndrome (ES) is a non-infectious complication seen both in autologous and allogeneic hematopoietic stem cell transplants and is characterized by the presence of non-infectious fever, diarrhea, skin rash, pulmonary infiltration, pulmonary edema, and deranged renal and liver function tests…
ES: A Spectrum of Disease Severities
Use of multiple nomenclatures in the ES literature has complicated the field. ES has been used synonymously with:
- capillary leak syndrome,
- autoaggression syndrome,
- periengraftment respiratory distress syndrome,
- and autologous graft-versus-host disease (AGVHD) [7,17-19].
Each of these syndromes encompasses all, or a subset, of symptoms that have been attributed to ES (Figure 1). Although the ES nomenclature appears to be widely accepted, the use of the term “AGVHD” and the relationship between AGVHD and ES is still debated…
Engraftment Syndrome in Multiple Myeloma
In a retrospective analysis by Katzel et al. [26] of 90 patients with multiple myeloma who received ASCT after melphalan therapy, 10% of patients developed ES according to the Spitzer or Maiolino criteria.
All patients developed a noninfectious fever, and 8 of 9 had diarrhea. A skin rash was evident in 4 patients, whereas pulmonary infiltrates were seen in 6 patients. Three of 4 patients who developed hypoxia responded to high-dose steroids, whereas the remaining patient died of multisystem failure. This patient did not receive steroid therapy until day 17. The incidence of ES reached 29% (13/45) in Maiolino et al.’s cohort of patients with myeloma [5].
Giralt et al. [27] reported 14 patients with myeloma who developed varied degrees of ES/AGVHD after ASCT and cyclosporine (CsA) treatment. Specifically, 10 patients developed mucositis, 8 patients developed kidney or liver complications, and 4 developed cardiac problems. Histologic signs of acute GVHD were evident in 7 patients. One patient was diagnosed with clinically and histologically evident GVHD and was responsive to steroid therapy.
In our retrospective analysis of 421 patients with myeloma, the incidence of ES reached 21% [9]. The most common symptoms were:
- fever,
- diarrhea,
- and rash.
Symptoms resolved spontaneously or with corticosteroid treatment in most patients (95%).
In contrast to most studies that document mild, treatable cases of ASCT-associated ES, our group reported the development of severe ES/AGVHD in patients undergoing ASCT [13].
Severe ES occurred in 5 of 223 patients (2%) with myeloma. Three of the 5 patients who developed complications were undergoing a second ASCT. Histologic signs of GVHD were seen in the skin, liver, and/or GI tract.
Lymphocytes, mononuclear cells, and neutrophils were reported in liver and GI biopsies. Histologic GVHD occurred on average within the first 2 weeks and commonly followed signs of ES. Patients were only partially responsive to steroid therapy, and 4 died because of complications from ES/AGVHD or from tumor relapse.
In agreement with this study, Goddard et al. [22] reported a fatal case of multiorgan (ie, skin, GI, liver), steroid-resistant AGVHD in a single myeloma patient undergoing secondary ASCT.
Liver and digestive tract biopsies after day 41 were indicative of grade IV GVHD and showed evidence of immune infiltration by lymphocytes and neutrophils. In a review of 388 ASCT patients, Cogbill et al. [12]reported the development of ES/AGVHD in 17 patients (4%), 16 of which were patients with myeloma.
Grades I to IV GVHD was diagnosed in biopsies from skin, liver, small intestine, and, most commonly, colon. Six of 16 patients died from sepsis (n = 4), central nervous system hemorrhage (n = 1), or relapse of disease (n = 1).
Collectively, these data highlight the potential for serious complications in patients who develop ES and encourage early detection and treatment.