Study of the Effect of Prophylactic Corticosteroids on the Incidence of Engraftment Syndrome in Multiple Myeloma Patients Undergoing Autologous Bone Marrow Transplant

Background: Engraftment syndrome (ES) is a recognized complication following autologous bone marrow transplantation (ABMT) in multiple myeloma (MM) patients, characterized by fever, rash, diarrhea, pulmonary infiltrates, and organ dysfunction. ES incidence varies according to patient-, disease-, and treatment-related factors. Previous studies have suggested that prophylactic corticosteroids may reduce the risk of its occurrence.
Objective: This study aimed to evaluate the effect of prophylactic corticosteroids use on the incidence of ES in MM patients undergoing ABMT, and its relationship with clinical characteristics, serum C-reactive protein (CRP) levels, hospitalization duration, and post-transplant outcomes.
Patients and Methods: This retrospective-prospective cohort study included 33 MM patients (mean age 52 ± 9 years; 66.7% female) who underwent ABMT at the Oncology Center, Mansoura University (November 2019 to May 2023) and received dexamethasone (4 mg IV or oral, twice daily) before or at engraftment. ES diagnosis was based on Maiolino and Spitzer criteria. Patients were followed until day +100 to assess disease status and overall survival (OS).
Results: Fever occurred in 54.5% of patients, diarrhea in 93.9%, and rash in 6.1%. According to Maiolino’s criteria, ES developed in 2 patients (6.1%), while only 1 patient (3.0%) met Spitzer’s criteria. The median CD34⁺ cell dose infused was 4.6 × 10⁶ cells/kg. At day +100, 93.9% of patients remained complete remission. Three-year OS was 75%. Hospitalization duration was shorter compared with historical non-prophylaxis cohorts.
Conclusion: Prophylactic corticosteroid use is associated with a markedly low incidence of ES in MM patients undergoing ABMT, without apparent increase in infection risk, and may contribute to shorter hospital stays and improved post-transplant recovery.