Incidence, risk factors and impact on transplant outcomes of cytokine release syndrome after infusion of haploidentical stem cells with anti-thymocyte globulin

Abstract Cytokine release syndrome (CRS) after stem cell infusion in anti-thymocyte globulin (ATG)-based haploidentical (haplo)-hematopoietic stem cell transplantation (SCT) is unclear. We reviewed charts of patients who underwent haplo-SCT between January 2020 and December 2020 and graded CRS. A total of 259 were enrolled in the study. CRS occurred in 103/259 (39.8%) of the recipients, including 83 (80.6%) cases of grade 1 CRS and 20 (19.4%) cases of grade 2 CRS. Severe CRS (grades 3–5) was not observed. Fever was the most common manifestation (89.3%), and all of them occurred only after peripheral blood stem cells (PBSC) infusion. In multivariable analysis, recipients age older than 55 years (OR 2.486(1.124–5.496), p = 0.024), higher CRP during conditioning (OR 3.011 (95%CI, 1.766–5.134), p < 0.001)), and received PBSC as sole stem cell source (OR 2.478 487 (95%CI, 1.077-5.700), p = 0.033) could predict the development of CRS. The 3-year OS was comparable with 80% (95%CI, 61–97) for grade 2 CRS, and 85% (95%CI, 80–90) for grade 0–1 CRS ( p = 0.288). GRFS in two groups were 69% (95%CI, 49–90) and 69% (95%CI, 63–75), respectively ( p = 0.653). Our results suggest that CRS was common in ATG-based haplo-SCT and did not affect survival.