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Pulmonary manifestations during neutrophil engraftment in recipients of allogeneic hematopoietic cell transplantation for myelofibrosis

Bone Marrow Transplantation (2025)Cite this article

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Allogeneic hematopoietic cell transplantation (alloHCT) is the only potentially curative modality for myelofibrosis (MF) [1]. Engraftment syndrome (ES), characterized by fever, skin rash, pulmonary infiltrates, respiratory distress, weight gain, hepatic and/or renal dysfunction, may develop as a complication of alloHCT [2,3,4,5]. During neutrophil engraftment in patients with MF, we observed the development of pulmonary infiltrates with or without associated hypoxemia. These manifestations may be related to pulmonary extramedullary hematopoiesis (EMH), which has been associated with MF [6]. We aimed to describe this engraftment-related pulmonary complication in MF and assess its association with pre-transplant patient and disease characteristics and impact on transplant outcomes.

This retrospective study included 83 patients with primary or secondary MF who underwent alloHCT between 2015 and 2020. Patient demographics, disease characteristics, disease status, molecular mutations, and HCT-related variables were collected from electronic health records. Patients were included if they developed pulmonary manifestations within 96 h pre- or post-neutrophil engraftment. Pulmonary manifestations of engraftment (PES) were defined as the onset of pulmonary opacities with or without hypoxemia. Patients with other causes for the pulmonary manifestations including infection, fluid overload, or left ventricular dysfunction were excluded.

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Author notes

  1. These authors contributed equally: Salman Otoukesh, Idoroenyi Amanam.

Authors and Affiliations

  1. Division of Leukemia, Gehr Family Center for Leukemia Research, Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA, USA

    Salman Otoukesh, Idoroenyi Amanam, Amandeep Salhotra, Andrew Artz, Shukaib Arslan, Ibrahim Aldoss, Karamjeet Sandhu, Paul Koller, Ahmed Aribi, Peter Curtin, Anthony Stein, Guido Marcucci, Monzr Al Malki, Haris Ali, Ryotaro Nakamura & Vinod Pullarkat

  2. Department of Biostatistics, City of Hope Medical Center, Duarte, CA, USA

    Dongyun Yang

  3. Department of Pharmacy, City of Hope Medical Center, Duarte, CA, USA

    Diana Samuels

  4. Department of Radiology, City of Hope Medical Center, Duarte, CA, USA

    Syed Rahmanuddin

Authors
  1. Salman Otoukesh
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  2. Idoroenyi Amanam
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  10. Paul Koller
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  11. Ahmed Aribi
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  14. Guido Marcucci
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  15. Monzr Al Malki
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  16. Haris Ali
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  17. Syed Rahmanuddin
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  18. Ryotaro Nakamura
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  19. Vinod Pullarkat
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Contributions

VP developed the study concept. SO and IA conducted the study and were responsible for data collection. DS assisted with data acquisition. DY performed the statistical analysis. SR reviewed and interpreted the imaging studies. VP, SO, IA, and DS drafted the manuscript. SO, IA, DY, DS, AS, AA, SA, IA, KS, PK, AA, PC, AS, GM, MA, HA, RS, RN, and VP contributed intellectual input and participated in the critical revision and final approval of the manuscript.

Corresponding author

Correspondence to Vinod Pullarkat.

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Competing interests

HA and MAM have received research support from Incyte. The remaining authors have no relevant conflicts of interest to declare.

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Otoukesh, S., Amanam, I., Yang, D. et al. Pulmonary manifestations during neutrophil engraftment in recipients of allogeneic hematopoietic cell transplantation for myelofibrosis. Bone Marrow Transplant (2025). https://doi.org/10.1038/s41409-025-02724-w

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  • DOI: https://doi.org/10.1038/s41409-025-02724-w

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