Clinical Characteristics of and Risk Factors for Capillary Leak Syndrome after Allogeneic Hematopoietic Stem Cell Transplantation_West China Medical Journal

Authors：

CHEN Xinchuan ,  LIU Ting , JIA Yongqian , LIU Zhigang , DAI Yang , LI Jianjun

Department of Hematology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

LIU Ting, Email: xinchuan_chen@163.com

Keywords：

异基因造血干细胞移植; 毛细血管渗漏综合征; 羟乙基淀粉

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【摘要】　目的　分析异基因造血干细胞移植术（allogeneic hematopoietic stem cell transplantation，allo-HSCT）后并发毛细血管渗漏综合征（capillary leak syndrome，CLS）的发生率、危险因素和结局，并探讨其防治措施。　方法　回顾性分析2005年6月-2011年2月住院的allo-HSCT术后14例并发CLS的临床资料。　结果　 CLS发生率为9.2%（14/152）。年龄、性别、诊断、HLA配型、预处理、CD34+细胞量、粒细胞集落刺激因子（granulocyte colony-stimulating factor，G-CSF）用量、植入时间均不能认定为造血干细胞移植后CLS诱发因素。　结论　 HSCT术后CLS诱因尚不清楚，采用限水、减量G-CSF、使用糖皮质激素和羟乙基淀粉等措施及时治疗，有助于控制CLS。
【Abstract】　Objective　 To study the occurrence rate, risk factors and outcomes of capillary leak syndrome (CLS) after allogeneic hematopoietic stem cell transplantation (allo-HSCT), and discuss its prevention and treatment.　Methods　 We retrospectively analyzed the clinical records of 14 allo-HSCT recipients complicated with CLS from June 2005 to February 2011.　Results　 Fourteen out of 152 patients developed CLS with a cumulative incidence of 9.2 %. None of the 8 clinical parameters including age, gender, underlying disease, donor type, conditioning regimen, CD34+ cell dose, granulocyte colony-stimulating factor (G-CSF) dosage, and days to neutrophil engraftment could be identified as risk factors for the occurrence of CLS.　Conclusions　 Risk factors for CLS after allo-HSCT have not been fully established. Restriction of water intake, administration of corticosteroids and hydroxyethyl starch can be beneficial for patients with CLS.

Citation： CHEN Xinchuan,LIU Ting,JIA Yongqian,LIU Zhigang,DAI Yang,LI Jianjun. Clinical Characteristics of and Risk Factors for Capillary Leak Syndrome after Allogeneic Hematopoietic Stem Cell Transplantation. West China Medical Journal, 2011, 26(12): 1774-1779. doi: Copy

1.	Tian J, Lin X, Guan R, et al. The effects of hydroxyethyl starch on lung capillary permeability in endotoxic rats and possible mechanisms[J]. Anesth Analg, 2004, 98(3): 768-774.
2.	Cahill RA, Spitzer TR, Mazumder A. Marrow engraftment and clinical manifestations of capillary leak syndrome[J]. Bone Marrow Transplant, 1996, 18(1): 177-184.
3.	Przepiorka D, Weisdorf D, Martin P, et al. 1994 Consensus Conference on Acute GVHD Grading[J]. Bone Marrow Transplant, 1995, 15(6): 825-828.
4.	Marx G, Vangerow B, Burczyk C, et al. Evaluation of noninvasive determinants for capillary leakage syndrome in septic shock patients[J]. Intensive Care Med, 2000, 26(9): 1252-1258.
5.	Marx G. Fluid therapy in sepsis with capillary leakage[J]. Eur J Anaesthesiol, 2003, 20(6): 429-442.
6.	Lee CK, Gingrich RD, Hohl RJ, et al. Engraftment syndrome in autologous bone marrow and peripheral stem cell transplantation[J]. Bone Marrow Transplant, 1995, 16(1): 175-182.
7.	Guan H, Nagarkatti PS, Nagarkatti M. Blockade of hyaluronan inhibits IL-2-induced vascular leak syndrome and maintains effectiveness of IL-2 treatment for metastatic melanoma[J]. J Immunol, 2007, 179(6): 3715-3723.
8.	de Azevedo AM, Goldberg Tabak D. Life-threatening capillary leak syndrome after G-CSF mobilization and collection of peripheral blood progenitor cells for allogeneic transplantation[J]. Bone Marrow Transplant, 2001, 28(3): 311-312.
9.	Stief TW. Capillary leak syndrome caused by cytostatics[J]. Ann Hematol, 2005, 84(7): 484.
10.	Takatsuka H, Takemoto Y, Yamada S, et al. Complications after bone marrow transplantation are manifestations of systemic inflammatory response syndrome[J]. Bone Marrow Transplant, 2000, 26(4): 419-426.
11.	李智泉, 王晨虹. 羟乙基淀粉和白蛋白扩容治疗对重度子痫前期并发毛细血管渗漏综合征肺功能的影响[J]. 临床急诊杂志, 2010, 11(5): 281-283.
12.	Lv R, Zhou W, Chu C, et al. Mechanism of the effect of hydroxyethyl starch on reducing pulmonary capillary permeability in a rat model of sepsis[J]. Ann Clin Lab Sci, 2005, 35(2): 174-183.
13.	Boldt J. Do plasma substitutes have additional properties beyond correcting volume deficits? [J]. Shock, 2006, 25(2): 103-116.
14.	Feng X, Yan W, Wang Z, et al. Hydroxyethyl starch, but not modified fluid gelatin, affects inflammatory response in a rat model of polymicrobial sepsis with capillary leakage[J]. Anesth Analg, 2007, 104(3): 624-630.
15.	Vincent JL. Plugging the leaks? New insights into synthetic colloids[J]. Crit Care Med, 1991, 19(3): 316-318.
16.	Hoffmann JN, Vollmar B, Laschke MW, et al. Hydroxyethyl starch (130 kD), but not crystalloid volume support, improves microcirculation during normotensive endotoxemia[J]. Anesthesiology, 2002, 97(2): 460-470.
17.	Atkinson JP, Waldmann TA, Stein SF, et al. Systemic capillary leak syndrome and monoclonal IgG gammopathy, studies in a sixth patient and a review of the literature[J]. Medicine (Baltimore), 1977, 56(3): 225-239.
18.	Chihara R, Nakamoto H, Arima H, et al. Systemic capillary leak syndrome[J]. Intern Med, 2002, 41(11): 953-956.

1. 　Tian J, Lin X, Guan R, et al. The effects of hydroxyethyl starch on lung capillary permeability in endotoxic rats and possible mechanisms[J]. Anesth Analg, 2004, 98(3): 768-774.
2. 　Cahill RA, Spitzer TR, Mazumder A. Marrow engraftment and clinical manifestations of capillary leak syndrome[J]. Bone Marrow Transplant, 1996, 18(1): 177-184.
3. 　Przepiorka D, Weisdorf D, Martin P, et al. 1994 Consensus Conference on Acute GVHD Grading[J]. Bone Marrow Transplant, 1995, 15(6): 825-828.
4. 　Marx G, Vangerow B, Burczyk C, et al. Evaluation of noninvasive determinants for capillary leakage syndrome in septic shock patients[J]. Intensive Care Med, 2000, 26(9): 1252-1258.
5. 　Marx G. Fluid therapy in sepsis with capillary leakage[J]. Eur J Anaesthesiol, 2003, 20(6): 429-442.
6. 　Lee CK, Gingrich RD, Hohl RJ, et al. Engraftment syndrome in autologous bone marrow and peripheral stem cell transplantation[J]. Bone Marrow Transplant, 1995, 16(1): 175-182.
7. 　Guan H, Nagarkatti PS, Nagarkatti M. Blockade of hyaluronan inhibits IL-2-induced vascular leak syndrome and maintains effectiveness of IL-2 treatment for metastatic melanoma[J]. J Immunol, 2007, 179(6): 3715-3723.
8. 　de Azevedo AM, Goldberg Tabak D. Life-threatening capillary leak syndrome after G-CSF mobilization and collection of peripheral blood progenitor cells for allogeneic transplantation[J]. Bone Marrow Transplant, 2001, 28(3): 311-312.
9. 　Stief TW. Capillary leak syndrome caused by cytostatics[J]. Ann Hematol, 2005, 84(7): 484.
10. 　Takatsuka H, Takemoto Y, Yamada S, et al. Complications after bone marrow transplantation are manifestations of systemic inflammatory response syndrome[J]. Bone Marrow Transplant, 2000, 26(4): 419-426.
11. 　李智泉, 王晨虹. 羟乙基淀粉和白蛋白扩容治疗对重度子痫前期并发毛细血管渗漏综合征肺功能的影响[J]. 临床急诊杂志, 2010, 11(5): 281-283.
12. 　Lv R, Zhou W, Chu C, et al. Mechanism of the effect of hydroxyethyl starch on reducing pulmonary capillary permeability in a rat model of sepsis[J]. Ann Clin Lab Sci, 2005, 35(2): 174-183.
13. 　Boldt J. Do plasma substitutes have additional properties beyond correcting volume deficits? [J]. Shock, 2006, 25(2): 103-116.
14. 　Feng X, Yan W, Wang Z, et al. Hydroxyethyl starch, but not modified fluid gelatin, affects inflammatory response in a rat model of polymicrobial sepsis with capillary leakage[J]. Anesth Analg, 2007, 104(3): 624-630.
15. 　Vincent JL. Plugging the leaks? New insights into synthetic colloids[J]. Crit Care Med, 1991, 19(3): 316-318.
16. 　Hoffmann JN, Vollmar B, Laschke MW, et al. Hydroxyethyl starch (130 kD), but not crystalloid volume support, improves microcirculation during normotensive endotoxemia[J]. Anesthesiology, 2002, 97(2): 460-470.
17. 　Atkinson JP, Waldmann TA, Stein SF, et al. Systemic capillary leak syndrome and monoclonal IgG gammopathy, studies in a sixth patient and a review of the literature[J]. Medicine (Baltimore), 1977, 56(3): 225-239.
18. 　Chihara R, Nakamoto H, Arima H, et al. Systemic capillary leak syndrome[J]. Intern Med, 2002, 41(11): 953-956.

West China Medical Journal

Clinical Characteristics of and Risk Factors for Capillary Leak Syndrome after Allogeneic Hematopoietic Stem Cell Transplantation

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