In June 2024, Blood Science published a significant study led by Dr. Xiaohui Zhang and colleagues from the Peking University People's Hospital, focusing on the incidence and risk factors of engraftment syndrome (ES) following autologous hematopoietic stem cell transplantation (ASCT) in the era of plerixafor-based mobilization. ASCT remains a critical therapy for hematologic malignancies, particularly in lymphoma and plasma cell disease, despite advancements in other treatments. However, ES, characterized by non-infectious fever, skin rash, diarrhea, and other clinical manifestations, remains a common and concerning complication post-ASCT.

The study aimed to evaluate the impact of plerixafor-based mobilization on the risk of ES, considering the influence of increased mononuclear cell (MNC) counts and other immune cell subsets in grafts. The researchers observed that plerixafor-based mobilization significantly increases the risk of ES, particularly in patients with plasma cell disease, highlighting the need for careful consideration of mobilization strategies in these patients.

Study Design and Patient Population

This retrospective study included 294 patients who underwent ASCT at the Peking University Institute of Hematology between January 2015 and December 2022. Patients were divided into groups based on their mobilization protocols and the occurrence of ES. The study focused on identifying the risk factors for ES, including age, disease status before ASCT, and the number of MNCs and T lymphocytes transfused.

Key Findings

The study found that 16% of the patients experienced ES, with the main symptoms being fever, diarrhea, skin rash, and hypoxemia or pulmonary edema. Multivariate analysis revealed that age ≥60 years, receiving ASCT at complete remission (CR), and higher MNC counts were significant risk factors for developing ES. Furthermore, in the plasma cell disease subgroup, plerixafor-based mobilization was identified as a significant risk factor for ES.

Visual Data Analysis

The figure illustrates the clinical manifestations of ES following ASCT. Fever was the most common symptom, occurring in 100% of ES cases, followed by diarrhea (78.7%), skin rash (23.4%), and hypoxemia or pulmonary edema (12.8%). Weight gain was the least common symptom, present in 4.3% of cases. This data underscores the varied clinical presentations of ES, with fever being a universal symptom in affected patients.

Figure. Engraftment syndrome presentation following autologoushematopoietic stem cell transplantation.

（Blood Science 6(3):p e00190, July 2024. | DOI: 10.1097/BS9.0000000000000190）

Conclusion

The study by Dr. Xiaohui Zhang underscores the increased risk of ES associated with plerixafor-based mobilization, particularly in patients with plasma cell disease. These findings suggest that plerixafor influences the composition of T lymphocytes in grafts, contributing to the development of ES. The identification of these risk factors is crucial for improving patient outcomes and guiding mobilization strategies in ASCT. Further prospective studies are needed to validate these findings and explore potential preventive measures for ES in high-risk populations.