Effect of risk adjustment methylprednisolone intervention on the prognosis of pre-engraftment syndrome after unrelated cord blood transplantation

Abstract

Abstract:

AIM: To retrospectively study the effect of risk adjustment methylprednisolone (MP) intervention on the prognosis of pre-engraftment syndrome (PES) and impacts on outcomes after unrelated cord blood transplantation (UCBT). METHODS: The data of 8 patients with acute leukemia underwent single or double UCBT from November 2012 to March 2015 were analyzed in this study, including 7 single UCBT and 1 double UCBT, half of the patients were acute lymphoblastic leukemia, and the other 4 patients were acute myeloid leukemia. All the patients were received intensified myeloablative conditioning, including 7 sTBI-based conditioning and one based on Flu. Treatment with risk adjustment methylprednisolone was given to all the patients for PES intervention. And for graft-versus-host disease (GVHD) prophylaxis, a combination of cyclosporine (CsA) and mycophenolate mofetil (MMF) was given. The cohort of patients were followed-up till to August 31, 2016. RESULTS:All the patients showed PES after UCBT and the incidence of PES was 100%. When compared the maximum C-reactive protein(CRP) level, the median value during PES was significantly higher than the serum level during conditioning therapy, after PES and the onset of II-IV acute GVHD (all P<0.05, respectively), and the result of patients received different doses of MP (0.5 mg·kg^-1·d^-1 and 1 mg·kg^-1·d^-1) showed no significant difference (P>0.05). Treatments based on different doses of MP showed a good clinical effect on PES, and there was no significant difference on transplant-related complications such as cumulative incidences of neutrophil engraftment, platelet recovery, II-IV and III-IV acute GVHD (all P>0.05, respectively). What's more, all the patients experienced infections in 100 days after UCBT. The incidence of bacterial infection was 75%, and the incidence of CMV infection was 100%. But in this study, no one experienced EBV infection after UCBT. In patients received MP 0.5 mg·kg^-1·d^-1, the incidence of bacterial infection was 50%, but it was 100% in those received MP 1 mg·kg^-1·d^-1. No significant difference was found between the 2 groups not only in infection, but also in the incidences of overall survival (OS) and relapse (P>0.05). CONCLUSION: PES seems to be common after UCBT, and MP is an effective intervention. Different doses of MP therapy based on the clinical manifestations of PES cases do not influence the results of UCBT in this cohort. Furthermore this approach can reduce patient transplant complications, improve the outcomes of UCBT and prolong the survival of patients underwent UCBT.

Key words: cord blood stem cell transplantation, pre-engraftment syndrome, methylprednisolone, retrospective studies

CLC Number:

R551

HUANG Laiquan, YAN Jiawei, WEI Zhongling, DAI Yan, SU Guiping, JIANG Yizhi, SUN Zimin, HUANG Dongping. Effect of risk adjustment methylprednisolone intervention on the prognosis of pre-engraftment syndrome after unrelated cord blood transplantation[J]. Chinese Journal of Clinical Pharmacology and Therapeutics, 2017, 22(4): 448-455.

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