Factors Affecting Survival in Children With Pericardial Effusion After Hematopoietic Stem Cell Transplantation

Abstract

The objective of this study was to determine the incidence, risk factors, outcome, and clinical significance of pericardial effusion (PE). We retrospectively analyzed outcomes of 272 pediatric patients undergoing their first hematopoietic stem cell transplantation (HSCT) from 1998 to 2016. In total, 15% (3/20) and 5.9% (15/252) of autologous and allogeneic HSCT recipients, respectively, were identified with PE. However, there was no statistically significant difference in the incidence of PE between the 2 groups. The mean age at transplantation was 11.12 ± 5.41 y. Eighteen patients developed PE at 4.13 ± 4.44 mo after HSCT. PE was confirmed by echocardiogram in all patients. Three patients presented with severe PE with cardiac tamponade and required urgent pericardiocentesis. Overall survival (OS) rates for patients who developed PE were 83.3% and 38.9% at 100 d and 3 y, respectively, after HSCT. Death was not directly attributable to PE in patients who died in the first year after HSCT. Multivariable analysis identified the following variables to be associated with OS: PE (relative risk[RR]: 3.70; 95% confidence interval [95% CI]: 1.89-7.23; P < 0.001), active disease at HSCT (RR: 1.59; 95% CI: 1.02-2.49; P < 0.001), and thalassemia (RR: 0.62; 95% CI: 0.45-0.84; P < 0.001). PE is, thus, a debilitating and significant complication of pediatric HSCT. Therefore, prospective studies are required for better determination of the etiology and optimal method of PE treatment after HSCT.

A fluid relationship: Calcineurin inhibitors and pericardial effusions

“…The cause of death for the one patient with PEF was secondary to disseminated toxoplasmosis, not related to the PEF. Although some studies have correlated PEF with higher mortality post‐HSCT, 1,6 a separate study determined that PEF had no effect on overall mortality 12 . Our results support the conclusion that PEF does not correlate with higher post‐HSCT mortality.…”

Risk Factors for Symptomatic Pericardial Effusions Posthematopoietic Stem Cell Transplant

“…This would argue that there is a need for more frequent monitoring for the development of PEF in these patients. However, the frequency of this monitoring has not been well delineated [ 2 , 3 ]. A prior single-center study implemented echocardiographic screening for all HSCT recipients admitted to the ICU with respiratory distress, hypoxia, shock, and complications related to ta-TMA and found abnormalities in 50% of patients (13% with pericardial effusions) [ 16 ].…”

“…Given the multiple comorbidities associated with HSCT, PEF requiring pericardiocentesis can be a high morbidity procedure [ 2 ]. Prior studies have shown PEF to be associated with worse overall survival after transplant and, in some studies, a significant risk factor for posttransplant mortality [ 2 , 3 ]. Therefore, addressing inflammatory triggers to prevent such procedures and identifying patients at higher risk for developing more severe PEF would have a high yield.…”

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

“…The incidence of PE in pediatric HSCT recipients is higher than in adult patients [6,7] ,but the reported incidence in pediatric patients varies widely across centers. Increased age, high-risk patients, ablative conditioning regimens, late neutrophil engraftment, relapse, GVHD, GVHD prophylaxis, donor type, TMA, and CMV viremias have been suggested to be potential risk factor [1,2,8,9] . Previously published report from our center [4] , 25 of 446(5.6%) children with thalassemia major developing a PE after HSCT, 11 patients with large PE, 11 patients with moderate PE, and 3 patients with mild PE, most of them were secondary to pulmonary infection.…”

“…PE is a life-threatening complication in HSCT patients with a risk of cardiac tamponade. The incidence of PE varies between 0.2% and 37.8% in HSCT recipients [1][2][3][4][5] . Currently there is no standard guidelines for the treatment of PE after HSCT and the choice of treatment varies between individuals.…”