TY - JOUR
T1 - Severe Cytokine Release Syndrome after Haploidentical Peripheral Blood Stem Cell Transplantation
AU - Imus, Philip H.
AU - Blackford, Amanda L.
AU - Bettinotti, Maria
AU - Luznik, Leo
AU - Fuchs, Ephraim J.
AU - Huff, Carol Ann
AU - Gladstone, Douglas E.
AU - Ambinder, Richard F.
AU - Borrello, Ivan M.
AU - Fuchs, Robert J.
AU - Swinnen, Lode J.
AU - Wagner-Johnston, Nina
AU - Gocke, Christian B.
AU - Ali, Syed Abbas
AU - Bolaños-Meade, F. Javier
AU - Jones, Richard J.
AU - Dezern, Amy E.
N1 - Funding Information:
Financial disclosure: This research was supported in part by National Institutes of Health Grant P01 CA015396 (R.J.J.) and National Cancer Institute Cancer Center Support Grant 3P30CA006973 .
Publisher Copyright:
© 2019 American Society for Transplantation and Cellular Therapy
PY - 2019/12
Y1 - 2019/12
N2 - Inflammatory 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.
AB - Inflammatory 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.
KW - Class II mismatch
KW - Cytokine release syndrome
KW - Haploidentical
KW - Peripheral blood
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U2 - 10.1016/j.bbmt.2019.07.027
DO - 10.1016/j.bbmt.2019.07.027
M3 - Article
C2 - 31394272
AN - SCOPUS:85071975817
SN - 1083-8791
VL - 25
SP - 2431
EP - 2437
JO - Biology of Blood and Marrow Transplantation
JF - Biology of Blood and Marrow Transplantation
IS - 12
ER -