Cardiac complications in patients undergoing a reduced-intensity conditioning hematopoietic stem cell transplantation

Abstract

Reduced-intensity conditioning (RIC) extends hematopoietic stem cell transplants (HSCT) to elderly or debilitated patients who are not candidates for HSCT. The incidence and outcomes of cardiac complications have been reported following myeloablative HSCT. We assessed the incidence and outcomes of cardiac complications in 278 recipients of RIC from July 2000 to July 2006. All patients received conditioning with BU, fludarabine and TBI. Patients were evaluated from conditioning therapy until 100 days after HSCT. Median age was 56 years. Cardiac events were defined as either one or more of the following: arrhythmias, myocardial infarction or congestive heart failure. Twenty-five patients developed arrhythmias at a median of 3 days post transplant, in 19 patients hemodynamic compromise occurred and mechanical ventilation was required in 15 patients. The arrhythmias included atrial fibrillation (n =17), atrial flutter (n =6) and supraventricular tachycardia (n =2). Troponin was elevated in 12 out of 25 patients. The mean brain natriuretic peptide was 679. All patients converted to a normal rhythm by medical therapy at a median of 2 days. Recurrence of arrhythmia occurred in 76% of patients. Day 100 mortality was 40% in this group. A history of high-dose anthracycline treatment and a low ejection fraction were risk factors for the development of cardiac complications.

Incidence of Supraventricular Arrhythmias during Autologous Peripheral Blood Stem Cell Transplantation

“…The median time of onset of arrhythmias was 9 days after AHCT and this is slightly later than the onset of between 3–7 days as reported by earlier studies [6, 8, 9]. Most arrhythmias were however short lasting with median duration of less than a day.…”

Factors affecting the development of atrial fibrillation and atrial flutter (AF/AFL) following autologous hematopoietic SCT (auto-HSCT)

“…Our findings that patients with an elevated creatinine level, prior mediastinal radiation or a history of previous arrhythmia were more likely to develop AF/ AFL, have not been described previously as potential risk factors for the development of AF/AFL in the post auto-HSCT period. [8][9][10] In our study, development of AF/AFL was not associated with a longer hospital stay, or inferior survival at 100 days. In contrast, Hidalgo et al, whose study included both allogeneic and autologous HSCT, found that development of AF/AFL prolonged hospitalization and predicted for higher 30-day mortality.…”

Changes of intracardiac hemodynamics in patients with decreased myocardial contractility at transplantation of cord blood stem cells

“…It was proved that stem cells improve patients' survival and quality of life [6]. However, several other studies have shown a chance of complications and adverse side effects at SCs transplantation [7][8][9]. These differences are explained by the use of SCs from various sources and, consequently, with different properties.…”

“…The cell preparation include of immature committed hematopoietic progenitors and mature blood cells. The number of nucleated cells in the samples ranged from 0.89·10 9 to 0.95·10 9 , the number of mononuclear cells -from 0.486·10 9 to 0.520·10 9 , CD34…”