Cardiac and pulmonary late effects do not negatively influence performance status and non‐relapse mortality of children surviving five yr after autologous hematopoietic cell transplantation: Report from the EBMT Paediatric Diseases and Late Effects Working Parties

Abstract

The current prospective study dealt with clinical outcome associated with pulmonary and cardiac late effects of AuHCT in children with malignancies. We prospectively evaluated 58 children, utilizing pulmonary function tests and cardiac shortening fraction, performed in pre-AuHCT phase and then annually. The overall five-yr survival was 68%. The five-yr cumulative incidence of lung and cardiac function impairment in survivors was 21% in both cases. None of the patients presented with restrictive or obstructive pulmonary pathology at the last follow-up and performance status for all survivors, ranged from 90% to 100%. The cumulative incidence of non-relapse mortality was 12.6% (range 6.3-25.3%), whereas relapse mortality was 19.7% (range 11.6-33.5). In conclusion, our study shows no significant deterioration in post-AuHCT pulmonary and cardiac function and in particular, no negative impact of lung and heart late effects on performance status and non-relapse mortality.

Busulphan-Cyclophosphamide Cause Endothelial Injury, Remodeling of Resistance Arteries and Enhanced Expression of Endothelial Nitric Oxide Synthase

“…Several factors such as the conditioning regimen, infections and alterations in the immune system have been recently addressed and related to late cardiovascular problems [11], [12]. Injury to the vascular system may lead to fatal organ dysfunction involving the cardiovascular [9], [13] or respiratory systems [14].…”

“…The high frequency of cardiovascular complications might indicate that the type and intensity of the conditioning regimen may play a role in their pathophysiology. In mouse models, the late complications appear to be less frequent in the syngeneic compared to the allogeneic settings [14].…”

Anesthetic considerations for the pediatric oncology patient – part 2: systems‐based approach to anesthesia

“…Chest radiation therapy and pulmonary toxic chemotherapy, especially when combined, can cause changes to lung function (62), and the risk of death from treatment‐related pulmonary causes is 8.8‐fold higher compared to a cohort of persons without cancer (88). For children treated with HSCT, there is significant clinical disease (72,76,80). In summary, the anesthesiologist must assess the presence of symptomatic pulmonary dysfunction as well as consider the possibility of occult respiratory compromise in the pediatric oncology patient.…”

“…Similar numbers have been seen in studies focusing on pediatric patients (72,75–79). A more recent study of pediatric patients who received autologous HSCT reported a 5‐year cumulative incidence of lung and cardiac function impairment in 21% of survivors, yet all survivors had a normal clinical performance status at the 5‐year mark (80). This outcome was in contrast to the 35% pulmonary and 26% cardiac impairment seen in the patients who received allogeneic HSCT at the same institution; the increased symptoms in the allogeneic transplantation group were most likely because of the increased risk of GVHD (76).…”

Ameliorative Effects of Quercetin in Cyclophosphamide-Induced Vascular Toxicity in Rats

“…The cardiovascular pathologies such as cardiotoxicity, heart failure and hypertension have been determined after systemic anticancer treatment (Senkus and Jassem 2011). Injury to the cardiovascular system the induced by anticancer agents like CYP may cause to fatal organ dysfunction consisting of the cardiovascular (Ghobrial et al 2004) or respiratory systems (Uderzo et al 2009). The mechanism of cardiovascular injury is thought to be associated with to vascular endothelium and myocytes damage mediated through its toxic metabolites (Kupari et al 1990).…”