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Severe Cytokine Release Syndrome after Haploidentical Peripheral Blood Stem Cell Transplantation

2019; Elsevier BV; Volume: 25; Issue: 12 Linguagem: Inglês

10.1016/j.bbmt.2019.07.027

1523-6536

Philip Imus, Amanda L. Blackford, Maria Bettinotti, Leo Luznik, Ephraim J. Fuchs, Carol Ann Huff, Douglas E. Gladstone, Richard F. Ambinder, Ivan Borrello, Robert J. Fuchs, Lode J. Swinnen, Nina D. Wagner‐Johnston, Christian B. Gocke, Syed Abbas Ali, F. Javier Bolaños-Meade, Richard J. Jones, Amy E. DeZern,

Chemotherapy-related skin toxicity

Highlights•Cytokine release syndrome (CRS) occurs at day 0 to day +5 in 90% of haploidentical peripheral blood stem cell transplant recipients.•Overall survival in our cohort was 58% at 2 years, because most CRS was mild.•Older patients and those who received radiation therapy are more prone to severe CRS.•Nonrelapse mortality was 38% at 6 months among patients with severe CRS.ABSTRACTInflammatory cytokines released by activated lymphocytes and innate cells in the context of cellular therapy can cause fever, vasodilatation, and end-organ damage, collectively known as cytokine release syndrome (CRS). CRS can occur after allogeneic blood or marrow transplantation, but is especially prevalent after HLA-haploidentical (haplo) peripheral blood transplantation (PBT). We reviewed charts of all patients who underwent haplo-PBT between October 1, 2013, and September 1, 2017 and graded CRS in these patients. A total of 146 consecutive patients who underwent related haplo-PBT were analyzed. CRS occurred in 130 patients (89%), with most cases of mild severity (grade 0 to 2). Severe CRS (grade 3 to 5) occurred in 25 patients (17%). In this group with severe CRS, 13 patients had encephalopathy, 12 required hemodialysis, and 11 were intubated. Death from the immediate complications of CRS occurred in 6 patients (24% of the severe CRS group and 4% of the entire haplo-PBT cohort). The cumulative probability of nonrelapse mortality (NRM) was 38% at 6 months for the patients with severe CRS and 8% (121 of 146) in patients without severe CRS. In conclusion, CRS occurs in nearly 90% of haplo-PBTs. Older haplo-PBT recipients (odds ratio [OR], 2.4; 95% confidence interval [CI], .83 to 6.75; P = .11) and those with a history of radiation therapy (OR, 3.85; 95% CI, 1.32 to 11.24; P = .01) are at increased risk of developing severe CRS. Although most recipients of haplo-PBT develop CRS, <20% experience severe complications. The development of severe CRS is associated with a significantly increased risk of NRM.