Effects of Systemic Steroid Administration on Recurrence of Pericardial Effusion in Pediatric Patients After Hematopoietic Stem Cell Transplantation

Abstract

Although rare in the general pediatric population, the incidence of pericardial effusion is significantly higher in pediatric patients undergoing hematopoietic stem cell transplant (HCT) with a reported incidence of up to 16.9%. The development of pericardial effusion in this setting is associated with higher mortality. Although pericardiocentesis is a relatively safe procedure for treating pericardial effusion, it is invasive, painful, and exposes an immunosuppressed patient to the risks of infection, bleeding, and injury to surrounding structures. Given the procedural risks of pericardiocentesis, systemic steroids are often administered for the treatment of pericardial effusion given their use for pericarditis in the general population. However, the effectiveness of systemic steroids for the treatment of pericardial effusion in the pediatric HCT population has not been confirmed. We studied the role of systemic steroids, administered at the time of initial pericardiocentesis performed for pericardial effusion, in preventing repeat pericardiocentesis. A total of 37 pericardiocenteses after HCT were performed during the study period with 25 patients undergoing first-time pericardiocentesis and 15 of those patients receiving systemic steroids. Eight patients required repeat pericardiocentesis; 5 of 15 (33%) received steroids and 3 of 10 (30%) did not receive steroids. Our data in this small cohort of pediatric HCT patients did not show a significant difference in the need for repeat pericardiocentesis with the use of systemic steroids, initiated within 48 hours of pericardiocentesis.

Successful Treatment of Massive Intractable Pericardial Effusion with Tocilizumab in a Child Undergone Allogeneic Hematopoietic Stem Cell Transplantation

“…Currently, there is no standard treatment for PE after HSCT due to the unclear pathogenesis. Therapy for PE should be aimed at its etiology if its cause is evident, such as infection and TMA; however, treatment options can be considered if the diagnosis is unclear or idiopathic, including discontinuation of calcineurin inhibitors, systemic steroid, enhanced immunosuppression, intravenous immunoglobulin, colchicine, and pericardiocentesis [3][4][5][10][11][12] . Colchicine is limited post-HSCT because of gastrointestinal effects and in-teractions with calcineurin inhibitors and azole antifungals [13] .…”

“…However, some patients are steroid refractory. Literature showed lack of significant effect from systemic steroids in the recurrent pericarditis, limited role of steroid in affecting the underlying mechanisms of effusion pathogenesis [11] . HAMADA, et al [15] found that IL-6-producing tissue-resident macrophages in early-onset pericardial effusion pathogenesis after HSCT.…”