Lawrence Chang, David Frame, Thomas Braun, Erin Gatza, David A

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Engraftment Syndrome after Allogeneic Hematopoietic Cell Transplantation Predicts Poor Outcomes Lawrence Chang, David Frame, Thomas Braun, Erin Gatza, David A. Hanauer, Shuang Zhao, John M. Magenau, Kathryn Schultz, Hemasri Tokala, James L.M. Ferrara, John E. Levine, Pavan Reddy, Sophie Paczesny, Sung Won Choi Biology of Blood and Marrow Transplantation Volume 20, Issue 9, Pages 1407-1417 (September 2014) DOI: 10.1016/j.bbmt.2014.05.022 Copyright © 2014 American Society for Blood and Marrow Transplantation Terms and Conditions

Figure 1 Distribution of study patients and outcomes. Steroids refer to engraftment syndrome (ES) treatment with systemic corticosteroids. ∗Graft-versus-host disease (GVHD) refers to maximum acute GVHD grade. †ES includes patients who met only 2 major Spitzer criteria but no minors, yet were advanced on systemic steroids in addition to those who also fulfilled the Spitzer criteria of 3 majors or 2 majors plus 1 minor criterion—all without the 96-hour time criterion for these signs and symptoms. Biology of Blood and Marrow Transplantation 2014 20, 1407-1417DOI: (10.1016/j.bbmt.2014.05.022) Copyright © 2014 American Society for Blood and Marrow Transplantation Terms and Conditions

Figure 2 Biomarker Studies. Shown are ■ ES versus No ES. Day 0 and day 14 mean change in plasma levels of (A) suppression of tumorigenicity 2 (ST2), ■ n = 43, n = 252; (B) interleukin 2 receptor α (IL2Rα), ■ n = 64, n = 165; (C) tumor necrosis factor receptor 1 (TNFR1), ■ n = 64, n = 165. Biology of Blood and Marrow Transplantation 2014 20, 1407-1417DOI: (10.1016/j.bbmt.2014.05.022) Copyright © 2014 American Society for Blood and Marrow Transplantation Terms and Conditions

Figure 3 Steroid Data. Median methylprednisolone equivalent dosing course over time dichotomized by baseline starting dose of ≥1.5 mg/kg/day (solid) and <1.5 mg/kg/d (dashed) at onset of engraftment syndrome (ES). The corresponding table shows hazard ratios of clinical outcomes comparing this baseline dichotomy. Biology of Blood and Marrow Transplantation 2014 20, 1407-1417DOI: (10.1016/j.bbmt.2014.05.022) Copyright © 2014 American Society for Blood and Marrow Transplantation Terms and Conditions

Figure 4 Clinical outcomes for engraftment syndrome (ES) and non-ES patients. Cumulative incidence of (A) acute GVHD grades 2 to 4, (B) overall survival, (C) relapse, and (D) nonrelapse mortality. Biology of Blood and Marrow Transplantation 2014 20, 1407-1417DOI: (10.1016/j.bbmt.2014.05.022) Copyright © 2014 American Society for Blood and Marrow Transplantation Terms and Conditions