Colitis Secondary to Engraftment Syndrome in a Patient with Autologous Peripheral Blood Stem Cell Transplant

Abstract

To the Editor, More than 30,000 autologous bone marrow transplantation are done annually worldwide [1]. Two-thirds of these bone marrow transplantations are done for multiple myeloma and non-Hodgkin’s lymphoma [1]. Other indications for autologous transplantation are Hodgkin’s lymphoma, acute myeloid leukemia, neuroblastoma, amyloidosis, autoimmune disorders and other conditions [1]. Engraftment syndrome is a potential complication of hematopoietic stem cell transplantation (HSCT). The syndrome is a febrile clinical condition that occurs in the early neutrophil recovery phase after hematopoietic stem cell transplantation [2]. It is characterized by noninfectious fever and various clinical findings, such as skin rash mimicking acute graftversus-host disease, diarrhea, pulmonary infiltrates, weight gain and neurological manifestations [3]. The pathogenesis of engraftment syndrome is not clearly understood, but involves the release of proinflammatory cytokines, including tumor necrosis factor-alpha and interleukin-1 resulting in increased capillary permeability [2, 3]. Engraftment syndrome has been described after allogeneic and autologous HSCT [4]. It is likely associated with increased mortality [2]. Corticosteroid is often effective therapy [2]. The incidence of engraftment syndrome varies from 7 to 59% depending on the definition used [4]. In 2003, Maiolinon et al. [4] introduced new diagnostic criteria for engraftment syndrome. These criteria are noninfectious fever plus any of the following: skin rash, diarrhea or pulmonary infiltrate [4]. The diarrhea is defined, in engraftment syndrome, as noninfectious diarrhea manifest as at least two episodes of liquid bowel movements per day without documentation of infection by standard procedures [4]. Based on this definition, the incidence of engraftment syndrome in autologous HSCT is 20% [4]. To our knowledge, the endoscopic findings in patients with colitis secondary to engraftment syndrome have never been reported.