Chest radiographic features of engraftment syndrome

About the time of hematopoietic engraftment, patients undergoing autologous hematopoietic stem cell transplantation in the form of peripheral blood stem cell transplantation (PSCT) may develop an "engraftment syndrome" that includes fever, skin rash, and capillary leak. This condition is usually self-limited, as opposed to other early complications of bone marrow transplantation such as infection and drug reactions. This article describes the chest radiographic manifestations of engraftment syndrome. The medical records and chest radiographs of 50 consecutive breast cancer patients who underwent PSCT were retrospectively reviewed. Engraftment syndrome was diagnosed if the expected clinical findings occurred at the time of engraftment of neutrophils and no other cause was identified. The chest radiographs were correlated with the clinical course. Sixteen patients were found to have engraftment syndrome (32%). Of these, eight had abnormal radiographs. Radiographic findings consisted of pleural effusions and interstitial pulmonary edema. No patient progressed to adult respiratory distress syndrome. Interstitial pulmonary edema and pleural effusions were observed in association with engraftment syndrome from PSCT. Correlation of these findings with clinical history and neutrophil count is important so that engraftment syndrome can be distinguished from other causes of fever.