Serious cardiac complications during bone marrow transplantation at the University of Minnesota, 1977–1997

Abstract

Summary:Cardiac complications may result from high-dose chemotherapy or irradiation administered during the conditioning phase of bone marrow and blood stem cell transplantation (BMT). To assess the frequency of clinically serious cardiac toxicity related to the acute phase of BMT, we retrospectively examined life-threatening or fatal cardiotoxicity identified using the complications records of our transplant center clinical database. All serious cardiac toxicity events within 100 days of BMT except those attributable to septic shock, pneumonitis or multi-organ failure were reviewed. Of 2821 BMT patients at the University of Minnesota between 1977 and 1997, 26 were identified as having suffered major or fatal (n = 13) cardiotoxicity (0.9%, 19 adults and seven children). Rapidly progressive heart failure resulted in death of 11 patients, one patient had fatal pericardial tamponade, and one had an acute ventricular fibrillation arrest. The remaining 13 patients (50%) had lifethreatening cardiotoxicity including four patients with pericardial tamponade and nine patients with cardiac arrhythmias. Overall, we observed that acute, major cardiotoxic events attributable to BMT are uncommon, occurring with a frequency of Ͻ1%. These data suggest that with appropriate pre-transplant clinical evaluation, high-dose cyclophosphamide and irradiation in the BMT preparative phase does not result in frequent, clinically relevant short-term cardiac toxicity. Bone Marrow Transplantation (2001) 28, 283-287.

Allo-hematopoietic cell transplantation for Ph chromosome-positive ALL: impact of imatinib on relapse and survival

“…The expected risk of a serious cardiac-related event (NCI CTC grade [4][5] in the first 100 days after allo-HCT has been previously estimated at our institution to be o1%. 31 What impact imatinib therapy may have on the cardiac risk for patients undergoing a myeloablative allo-HCT has not been extensively studied. There was a brief report by Sohn et al 13 who identified two accelerated phase CML patients treated with imatinib therapy prior to a myeloablative allo-HCT who later developed CHF at days þ 5 and þ 27 after HCT.…”

Cardiac toxicity of high-dose chemotherapy

“…76,101 However, measurement of LVEF before HD chemotherapy is of limited practical value: increased rates of minor cardiac events, rather than increased mortality due to severe cardiac toxicity, were recorded among patients with diminished (ie 50-54%) baseline LVEF, and 2/3 major cardiac events occurred in patients with normal LVEF. 100 Overall, resting LVEF measurement in every HD chemotherapy candidate is not recommended; 76,100 published evidence 7,25,76,79,100,106 suggests that for patients undergoing front-line HD chemotherapy cardiologic evaluation including a detailed history, physical examination, chest X-ray and resting ECG is likely to be a sufficient screening tool to recognize candidates at high risk for cardiac complications. On the other hand, full pre-transplant evaluation with resting 2D echo of patients with history, symptoms or signs of cardiac disease or a history of anthracycline exposure and/or left chest wall radiotherapy remains prudent.…”

Pericardial effusion post transplantation predicts inferior overall survival following allo-hematopoietic stem cell transplant

“…1,2 The exact incidence and risk factors are not well established, but retrospective reviews report PE occurring in 0.2-19% of HSCT patients. 1,3,4 Age, gender, disease risk, conditioning regimen, neutrophil engraftment, relapse, GVHD, GVHD prophylaxis, donor type and CMV viremias have been suggested as potential risk factors. 1,[4][5][6][7] The initial symptoms of PE can be non-specific, thus early recognition of PE may allow us to further optimize care and improve outcomes.…”