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Tong K, Meng Y, Zhang L, Lei X, Liu Q, Guan X, Yu J, Dou Y. Risk factors and survival outcomes in children with early cardiotoxicity after allogeneic hematopoietic stem cell transplantation. Ann Hematol 2024; 103:2485-2497. [PMID: 38709259 DOI: 10.1007/s00277-024-05787-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 05/01/2024] [Indexed: 05/07/2024]
Abstract
Cardiotoxicity in children is a potentially fatal complication after allogeneic hematopoietic stem cell transplantation (allo-HSCT); therefore, early identification of risk factors can improve patient prognosis. However, there are few data on the clinical characteristics of early-stage cardiotoxicity in children after allo-HSCT. We conducted a retrospective single-center study of pediatric patients who underwent allogeneic hematopoietic stem cell transplantation (allo-HSCT) between January 2016 and December 2022 at the Children's Hospital Affiliated with Chongqing Medical University to evaluate the clinical characteristics of early cardiac events (ECEs) after allo-HSCT and their impact on survival outcomes. We enrolled 444 patients who underwent allo-HSCT-304 males (68%) and 140 females (32%)-with a median age of 3.3 years (1.8-6.5 years) at transplantation. We found that 73 patients (16.4%) had ECEs after allo-HSCT. The ECEs included valvular disease (n = 46), pericardial effusion (n = 38), arrhythmia (n = 9), heart failure (n = 16), and dilated cardiomyopathy (n = 1). Female sex, age ≥ 6 years, body mass index (BMI) < 16 kg/m2 and HLA-type mismatches were risk factors for ECEs. We designed a stratified cardiac risk score that included these risk factors, and the higher the score was, the greater the cumulative incidence of ECEs. The occurrence of an ECE was closely associated with a lower overall survival (OS) rate and greater nonrelapse mortality (NRM). In addition, stratified analysis based on the number of combined ECEs showed that the greater the number of combined ECEs was, the more significant the negative impact on OS rates.
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Affiliation(s)
- Ke Tong
- Department of Hematology and Oncology, National Clinical Research Center for Child Health and Disorders Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Yan Meng
- Department of Hematology and Oncology, National Clinical Research Center for Child Health and Disorders Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Luying Zhang
- Department of Hematology and Oncology, National Clinical Research Center for Child Health and Disorders Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Xiaoying Lei
- Department of Hematology and Oncology, National Clinical Research Center for Child Health and Disorders Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Qihui Liu
- Department of Hematology and Oncology, National Clinical Research Center for Child Health and Disorders Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Xianmin Guan
- Department of Hematology and Oncology, National Clinical Research Center for Child Health and Disorders Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Jie Yu
- Department of Hematology and Oncology, National Clinical Research Center for Child Health and Disorders Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Ying Dou
- Department of Hematology and Oncology, National Clinical Research Center for Child Health and Disorders Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, People's Republic of China.
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Hayek SS, Zaha VG, Bogle C, Deswal A, Langston A, Rotz S, Vasbinder A, Yang E, Okwuosa T. Cardiovascular Management of Patients Undergoing Hematopoietic Stem Cell Transplantation: From Pretransplantation to Survivorship: A Scientific Statement From the American Heart Association. Circulation 2024; 149:e1113-e1127. [PMID: 38465648 DOI: 10.1161/cir.0000000000001220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
Hematopoietic stem cell transplantation can cure various disorders but poses cardiovascular risks, especially for elderly patients and those with cardiovascular diseases. Cardiovascular evaluations are crucial in pretransplantation assessments, but guidelines are lacking. This American Heart Association scientific statement summarizes the data on transplantation-related complications and provides guidance for the cardiovascular management throughout transplantation. Hematopoietic stem cell transplantation consists of 4 phases: pretransplantation workup, conditioning therapy and infusion, immediate posttransplantation period, and long-term survivorship. Complications can occur during each phase, with long-term survivors facing increased risks for late effects such as cardiovascular disease, secondary malignancies, and endocrinopathies. In adults, arrhythmias such as atrial fibrillation and flutter are the most frequent acute cardiovascular complication. Acute heart failure has an incidence ranging from 0.4% to 2.2%. In pediatric patients, left ventricular systolic dysfunction and pericardial effusion are the most common cardiovascular complications. Factors influencing the incidence and risk of complications include pretransplantation therapies, transplantation type (autologous versus allogeneic), conditioning regimen, comorbid conditions, and patient age. The pretransplantation cardiovascular evaluation consists of 4 steps: (1) initial risk stratification, (2) exclusion of high-risk cardiovascular disease, (3) assessment of cardiac reserve, and (4) optimization of cardiovascular reserve. Clinical risk scores could be useful tools for the risk stratification of adult patients. Long-term cardiovascular management of hematopoietic stem cell transplantation survivors includes optimizing risk factors, monitoring, and maintaining a low threshold for evaluating cardiovascular causes of symptoms. Future research should prioritize refining risk stratification and creating evidence-based guidelines and strategies to optimize outcomes in this growing patient population.
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Tong K, Meng Y, Zhang L, Lei X, Guan X, Xiao L, Yu J, Dou Y. Retrospective study of risk factors for pericardial effusion after haematopoietic stem cell transplantation in children. Hematology 2023; 28:2245259. [PMID: 37551721 DOI: 10.1080/16078454.2023.2245259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 08/02/2023] [Indexed: 08/09/2023] Open
Abstract
OBJECTIVES The clinical characteristics, risk factors and survival prognosis of pericardial effusion (PE) after haematopoietic stem cell transplantation (HSCT) in children were investigated. METHODS Clinical data of children who underwent HSCT at the Children's Hospital Affiliated with Chongqing Medical University from January 2016 to December 2022 were analysed retrospectively. Cox proportional hazards regression and the Kaplan-Meier method were used to analyse the risk factors for post-HSCT PE and its impact on outcomes, respectively. RESULTS We enrolled 452 patients with HSCT: 307 males and 145 females, with a median age of 3.4 (1.8 to 6.5) years at transplantation. Forty-five patients (10%) had PE within a median time of 25 (10.5 to 44) days, 42 (93%) within 100 days. Three patients with large PE were treated with pericardiocentesis and drainage, while the others were treated conservatively. Of the 45 patients with PE, 24 survived, and their PE disappeared after treatment. Graft-versus-host disease (GVHD) grade, abnormal pre-HSCT electrocardiogram, hepatic veno-occlusive disease (HVOD), pulmonary infection and Epstein-Barr virus (EBV) infection were risk factors for PE. The overall survival (OS) rates at 1, 3, and 5 years were 86.0%, 84.2%, and 82.3%, respectively. PE had a significant negative effect on OS after HSCT (P < 0.0001). Particularly, one patient with large PE died of pericardial tamponade. CONCLUSIONS Post-HSCT PE usually occurred within 100 days. GVHD grade, abnormal pre-HSCT electrocardiogram, HVOD, pulmonary infection and EBV infection were closely related to PE. PE had a significant negative effect on OS rate.
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Affiliation(s)
- Ke Tong
- Department of Hematology and Oncology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, People's Republic of China
| | - Yan Meng
- Department of Hematology and Oncology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, People's Republic of China
| | - Luying Zhang
- Department of Hematology and Oncology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, People's Republic of China
| | - Xiaoying Lei
- Department of Hematology and Oncology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, People's Republic of China
| | - Xianmin Guan
- Department of Hematology and Oncology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, People's Republic of China
| | - Li Xiao
- Big Data Center for Children's Medical Care, Children's Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Jie Yu
- Department of Hematology and Oncology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, People's Republic of China
| | - Ying Dou
- Department of Hematology and Oncology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, People's Republic of China
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Ahmad I, Souchet L, Hamzy F, Ceballos P, Desbrosses Y, Ravinet A, Turlure P, Villate A, Borel C, Benbarkat H, Yakoub-Agha I, Guillaume T. [Cardiac complications following allogeneic hematopoietic stem cell transplantation: Recommendations of the SFGM-TC]. Bull Cancer 2023; 110:S56-S66. [PMID: 35662519 DOI: 10.1016/j.bulcan.2022.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 03/22/2022] [Accepted: 03/30/2022] [Indexed: 10/18/2022]
Abstract
Autologous and allogeneic hematopoietic stem cell transplantation (HSCT) can lead to early cardiac complications as well as late sequelae. A cardiac evaluation is essential in the pre-transplant assessment given the patient's comorbidities and previous chemotherapy treatments received. Various thresholds of cardiac function are recommended as eligibility criteria. The rise of haplo-identical transplantation with the use of post-transplant high-dose cyclophosphamide (PT-Cy) as a prophylaxis against graft-versus-host disease (GVHD) is accompanied by a resurgence of cardiological concerns. Arrhythmias are also a concern and the list of drugs implicated in this complication is growing. The rare occurrence of cardiac GVHD has been reported, although the entity is not well defined. Finally, although long-term follow-up recommendations exist, they are not accompanied by specific targets for cardiovascular risk factors, the presence of which is nevertheless increased after HSCT. In the framework of the Francophone Society of Bone Marrow Transplantation and Cellular Therapy (SFGM-TC) practice harmonization workshops held in Lille in September 2019, the prophylaxis, the diagnostic approach and the treatments of cardiac complication following HSCT were reviewed after analysis of published studies.
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Affiliation(s)
- Imran Ahmad
- Université de Montréal, hôpital Maisonneuve-Rosemont, service d'hématologie et oncologie médicale, 5415 Boulevard de l'Assomption, Montréal, QC, H1T2M4, Canada
| | - Laetitia Souchet
- Centre hospitalier La Pitié-Salpêtrière, service d'hématologie, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - Fati Hamzy
- Hôpital Universitaire International Cheikh Zaïd, Cite al Irfane-Hay Ryad, service d'hématologie et greffe de moelle osseuse, Av. Allal al Fassi, BP 6533, Rabat, Maroc
| | - Patrice Ceballos
- Centre hospitalier Saint-Éloi, UGH hématologie, 80, avenue Augustin-Fliche, 34080 Montpellier, France
| | - Yohann Desbrosses
- CHRU Jean-Minjoz Besançon, service d'hématologie, 3, boulevard Flemming, 25030 Besançon cedex, France
| | - Aurélie Ravinet
- CHU Estaing, université d'Auvergne, service d'hématologie, 1, place Lucie-Aubrac, 63000 Clermont-Ferrand, France
| | - Pascal Turlure
- CHU Dupuytren Limoges, service d'hématologie, 2, avenue Martin-Luther-King, 87000 Limoges, France
| | - Alban Villate
- CHU Bretonneau Tours, service d'hématologie et thérapie cellulaire, 2, boulevard Tonnelé, 37044 Tours cedex 9, France
| | - Cécile Borel
- Institut universitaire du cancer de Toulouse - Oncopole, service d'hématologie, 1, avenue Irène-Joliot-Curie, 31100 Toulouse, France
| | - Hanane Benbarkat
- Université de Montréal, hôpital Maisonneuve-Rosemont, service de cardiologie, 5415 Boulevard de l'Assomption, Montréal, QC, H1T2M4, Canada
| | - Ibrahim Yakoub-Agha
- CHU de Lille, université de Lille, service d'hématologie, Infinite, Inserm U1286, 59000 Lille, France
| | - Thierry Guillaume
- CHU de Nantes, Hôtel-Dieu, service d'hématologie clinique, 1, place Ricordeau, 44000 Nantes, France.
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Towards a Better Understanding of the Atypical Features of Chronic Graft-Versus-Host Disease: A Report from the 2020 National Institutes of Health Consensus Project Task Force. Transplant Cell Ther 2022; 28:426-445. [PMID: 35662591 PMCID: PMC9557927 DOI: 10.1016/j.jtct.2022.05.038] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 05/16/2022] [Accepted: 05/24/2022] [Indexed: 12/31/2022]
Abstract
Alloreactive and autoimmune responses after allogeneic hematopoietic cell transplantation can occur in non-classical chronic graft-versus-host disease (chronic GVHD) tissues and organ systems or manifest in atypical ways in classical organs commonly affected by chronic GVHD. The National Institutes of Health (NIH) consensus projects were developed to improve understanding and classification of the clinical features and diagnostic criteria for chronic GVHD. While still speculative whether atypical manifestations are entirely due to chronic GVHD, these manifestations remain poorly captured by the current NIH consensus project criteria. Examples include chronic GVHD impacting the hematopoietic system as immune mediated cytopenias, endothelial dysfunction, or as atypical features in the musculoskeletal system, central and peripheral nervous system, kidneys, and serous membranes. These purported chronic GVHD features may contribute significantly to patient morbidity and mortality. Most of the atypical chronic GVHD features have received little study, particularly within multi-institutional and prospective studies, limiting our understanding of their frequency, pathogenesis, and relation to chronic GVHD. This NIH consensus project task force report provides an update on what is known and not known about the atypical manifestations of chronic GVHD, while outlining a research framework for future studies to be undertaken within the next three to seven years. We also provide provisional diagnostic criteria for each atypical manifestation, along with practical investigation strategies for clinicians managing patients with atypical chronic GVHD features.
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Characterization of Pericarditis following Allogeneic Hematopoietic Cell Transplantation. Transplant Cell Ther 2021; 27:934.e1-934.e6. [PMID: 34339867 DOI: 10.1016/j.jtct.2021.07.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 07/17/2021] [Accepted: 07/25/2021] [Indexed: 11/23/2022]
Abstract
Pericarditis is an uncommon cardiac complication following allogeneic hematopoietic cell transplantation (alloHCT), with limited data characterizing its incidence, presentation, and management. The etiology of pericarditis in this setting is poorly understood and may include conditioning-related toxicity, infection, or graft-versus-host disease (GVHD). The objective of the present study was to characterize the clinical presentation, management, and outcomes of post-alloHCT pericarditis observed at a single center. This retrospective case-control study of consecutive adults undergoing alloHCT over 5 years was conducted to identify patients who developed pericarditis. Pericarditis was diagnosed using clinical, electrocardiography, and echocardiography findings. Identified cases were compared with a cohort of patients who underwent alloHCT during the same period but did not develop pericarditis. A total of 620 patients underwent alloHCT over the 5-year period, 20 of whom developed pericarditis (3.2% incidence). One patient had a pre-alloHCT history of pericarditis. All but 3 patients had received anthracycline therapy and 1 patient had received chest irradiation before undergoing alloHCT. Patients with pericarditis were more likely than patients without pericarditis to have received total body irradiation (odds ratio [OR], 4.57; P = .003) or cyclophosphamide (OR, 2.35; P = .07) as conditioning or GVHD prophylaxis. Fourteen patients experienced their initial episode of pericarditis before day +100 post-alloHCT, with a median time to onset at day +7. Six patients had their initial episode on day +100 or later, with a median time to onset at day +268. Only 1 patient had active, previously diagnosed GVHD, and 3 patients were on systemic steroid therapy at the time of pericarditis diagnosis. Pericarditis was treated primarily with colchicine (median duration 91 days). Seven episodes of recurrence occurred in 5 patients. Two patients experienced cardiac tamponade following their initial diagnosis, and 3 developed tamponade at recurrence. Recurrence was more common in patients who received no or <90 days of colchicine compared with those who received ≥90 days (45.5% vs 0%; P = .02). No cardiac-related deaths occurred. Overall survival was 85% at a median follow-up of 30 months post-alloHCT. Pericarditis occurred in 3.2% of patients in this single-center study, with cases observed both before and after day +100 and some cases occurring ≥1 year after alloHCT. Colchicine was an effective intervention, with ≥90 days of treatment associated with reduced recurrence. Pericarditis should be considered in patients presenting with chest pain following alloHCT.
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Idiopathic refractory ascites after allogeneic stem cell transplantation: a previously unrecognized entity. Blood Adv 2021; 4:1296-1306. [PMID: 32236526 DOI: 10.1182/bloodadvances.2019000638] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 02/27/2020] [Indexed: 11/20/2022] Open
Abstract
At our center, we observed a series of patients who developed transudative refractory ascites secondary to noncirrhotic, non-veno-occlusive disease (VOD)-related portal hypertension after allogeneic hematopoietic stem cell transplantation (allo-HSCT). Patients were considered to have idiopathic portal hypertension-related refractory ascites (IRA) if they developed ascites secondary to intrahepatic portal hypertension (serum ascites albumin gradient ≥1.1 g/dL or hepatic venous pressure gradient [HVPG] >5 mm Hg), but did not meet the clinical criteria for classical VOD/sinusoidal obstructive syndrome (SOS) and did not have any alternate etiology of portal hypertension. From our institutional database, we identified 40 patients who developed IRA after allo-HSCT between 2004 and 2018. The patients' median age at the time of allo-HSCT was 54 years (range, 21-73 years). The median time to development of IRA after allo-HSCT was 80 days (range, 16-576 days). The median number of paracentesis was 3 (range, 1-11), and 15 (38%) patients had an intraperitoneal catheter placed for continued drainage of the rapidly accumulating ascites. Portal pressures were measured in 19 patients; 6 (15%) had moderate portal hypertension (HVPG 6-9 mm Hg), and 13 (33%) had severe portal hypertension (HVPG ≥ 10 mm Hg). Liver biopsy was performed in 24 patients. None of the patients met the criteria for classical VOD/SOS (clinical/histological) or cirrhosis (histological). The cumulative incidence of nonrelapse mortality was 63%, and the median survival duration after the development of the IRA was 7 months (range, 0.8-125.6 months). IRA is a poorly understood and often fatal complication of allo-HSCT.
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Rapid Onset of Hypoxemia in a Man with Graft-versus-Host Disease after Stem Cell Transplant Leukemia. Ann Am Thorac Soc 2019; 14:283-287. [PMID: 28146374 DOI: 10.1513/annalsats.201606-460cc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Shimomura Y, Sakai S, Ueda H, Fujikura K, Imai Y, Ishikawa T. Encapsulating peritoneal sclerosis in a patient after allogeneic hematopoietic stem cell transplantation: a case report. BMC Gastroenterol 2019; 19:12. [PMID: 30665354 PMCID: PMC6341688 DOI: 10.1186/s12876-019-0933-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 01/16/2019] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Encapsulating peritoneal sclerosis (EPS) is a chronic clinical syndrome of acute or subacute gastrointestinal obstruction seen mainly in patients undergoing peritoneal dialysis. Although there are a few reports on EPS developing in non-peritoneal dialysis patients, it has not been reported in patients undergoing allogeneic haematopoietic stem cell transplantation (HSCT). Here, we report a case of EPS after a second HSCT. CASE PRESENTATION A 46-year-old man with myelodysplastic syndrome showed relapse after HSCT and received a second HSCT. The patient was diagnosed with chronic graft-versus-host disease (cGVHD)-associated serositis because of persistent ascites. His ascites improved gradually and disappeared without immunosuppressive therapy. He presented with nausea, weight loss, and constipation 1 year after improvement of ascites. Computed tomography revealed no organic obstruction, but did reveal dilated, thickened, and adhered small bowel loops with a mass-like appearance. He was diagnosed with EPS on the basis of clinical symptoms and image findings. He received corticosteroid therapy (20 mg/body) without any improvement in symptoms. He developed recurrence of myelodysplastic syndrome at 1 month after initiation of corticosteroid therapy. This progressed into acute myeloid leukaemia after 3 months. He died 31 months after the second HSCT. At autopsy, the small and large intestines had formed extensive adhesions and showed signs of progressive fibrosis with peritoneal sclerosis, fibroblast swelling, fibrin deposition, and inflammatory cell infiltration, which confirmed the diagnosis of EPS. CONCLUSION This case suggests that EPS may complicate patients with cGVHD-associated serositis. Although the mechanism of EPS development is not clear, clinicians should be aware of this eventuality.
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Affiliation(s)
- Yoshimitsu Shimomura
- Department of Hematology, Kobe City Hospital Organization, Kobe City Medical Center General Hospital, 2-1-1 Minatojima-Minamimachi, Chuo-ku, Kobe, 650-0047 Japan
| | - Shinsuke Sakai
- Department of Nephrology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Hiroyuki Ueda
- Department of Diagnostic Radiology, Kobe City Hospital Organization, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Kohei Fujikura
- Department of Clinical Pathology, Kobe City Hospital Organization, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Yukihiro Imai
- Department of Clinical Pathology, Kobe City Hospital Organization, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Takayuki Ishikawa
- Department of Hematology, Kobe City Hospital Organization, Kobe City Medical Center General Hospital, 2-1-1 Minatojima-Minamimachi, Chuo-ku, Kobe, 650-0047 Japan
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Nasser K, Joshi K, Starobinska E. Pericardial effusion as a complication of chronic graft versus host disease. BMJ Case Rep 2018; 11:11/1/e227507. [PMID: 30567271 DOI: 10.1136/bcr-2018-227507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 24-year-old man with previous matched unrelated donor allogenic bone marrow transplant for aplastic anaemia and chronic graft versus host disease on steroid taper presented with progressively worsening anasarca. CT revealed large pericardial effusion, while echocardiogram was concerning for early tamponade physiology. He underwent emergent pericardiocentesis with pericardial drain placement. Extensive rheumatological and infectious work-up was unrevealing with patient's presentation attributed to pericardial graft versus host disease. This highlights the need of physicians to be aware of pericardial serositis as a complication of graft versus host disease due to its life-threatening complications, which require immediate intervention.
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Affiliation(s)
- Keaton Nasser
- Internal Medicine, Banner University Medical Center, Tucson, Arizona, USA
| | - Kshipra Joshi
- Internal Medicine, Banner University Medical Center, Tucson, Arizona, USA
| | - Ella Starobinska
- Internal Medicine, Banner University Medical Center, Tucson, Arizona, USA
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Jaing TH, Chen SH, Wen YC, Chang TY, Tsai DY, Chung HT, Tsay PK. Factors Affecting Survival in Children With Pericardial Effusion After Hematopoietic Stem Cell Transplantation. Cell Transplant 2018; 26:1792-1797. [PMID: 29338379 PMCID: PMC5784522 DOI: 10.1177/0963689717727285] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
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.
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Affiliation(s)
- Tang-Her Jaing
- 1 Division of Hematology/Oncology, Department of Pediatrics, Chang Gung Children's Hospital, Chang Gung University, Linkou, Taoyuan
| | - Shih-Hsiang Chen
- 1 Division of Hematology/Oncology, Department of Pediatrics, Chang Gung Children's Hospital, Chang Gung University, Linkou, Taoyuan
| | - Yu-Chuan Wen
- 2 Department of Nursing, Chang Gung Memorial Hospital, Chang Gung University, Linkou, Taoyuan
| | - Tsung-Yen Chang
- 1 Division of Hematology/Oncology, Department of Pediatrics, Chang Gung Children's Hospital, Chang Gung University, Linkou, Taoyuan
| | - Dai-Yun Tsai
- 2 Department of Nursing, Chang Gung Memorial Hospital, Chang Gung University, Linkou, Taoyuan
| | - Hung-Tao Chung
- 3 Division of Cardiology, Department of Pediatrics, Chang Gung Children's Hospital, Chang Gung University, Linkou, Taoyuan
| | - Pei-Kwei Tsay
- 4 Department of Public Health and Center of Biostatistics, College of Medicine, Chang Gung University, Linkou, Taoyuan, Taiwan
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Cox K, Punn R, Weiskopf E, Pinsky BA, Kharbanda S. Pericardial Effusion Following Hematopoietic Cell Transplantation in Children and Young Adults Is Associated with Increased Risk of Mortality. Biol Blood Marrow Transplant 2017; 23:1165-1169. [PMID: 28390986 DOI: 10.1016/j.bbmt.2017.03.028] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 03/18/2017] [Indexed: 11/29/2022]
Abstract
Hematopoietic cell transplantation (HCT) is curative for many pediatric malignant and nonmalignant disorders but is associated with significant morbidity and mortality, including the development of pericardial effusion (PEF). We report the results of a retrospective chart review performed to assess the incidence, risk factors, and prognostic significance of PEF in pediatric HCT recipient at Lucile Packard Children's Hospital of Stanford University. A total of 119 patients undergoing HCT between January 2010 and December 2013 were selected through the hospital's Pediatric Stem Cell Transplant Program database. A retrospective chart review, including review of documentation, correspondence, imaging reports, laboratory values, and death records, was performed to collect data. The overall incidence of PEF in our population was 21%. Risk factors for the development of PEF included unrelated donor transplants and cord blood as the stem cell source (P = .005), whereas HLA mismatch approached significance (P = .05). The risk for development of PEF was found to not be significantly associated with acute or chronic graft-versus-host disease (GVHD), age at transplantation, sex, conditioning regimen, or viral reactivation status. Of interest, 6 of the 119 patients were found to have transplant-associated thrombotic microangiopathy (TA-TMA). Four of those 6 patients developed PEF, suggesting TA-TMA as a risk factor for PEF. Eight of the 25 patients who developed PEF (32%) required pericardiocentesis. Five out of the 8 patients requiring pericardiocentesis died owing to causes unrelated to the procedure or to PEF itself. Pericardial fluid testing in 4 of these patients (50%) was positive for human herpesvirus 6, Epstein-Barr virus, cytomegalovirus, and/or adenovirus. Finally, of significant interest, patients with PEF had a statistically significant higher likelihood of mortality compared with those without PEF (44% versus 17%; P = .007).
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Affiliation(s)
- Kelly Cox
- Department of Pediatrics, Division of Cardiology, Stanford University School of Medicine, Stanford, California
| | - Rajesh Punn
- Department of Pediatrics, Division of Cardiology, Stanford University School of Medicine, Stanford, California
| | - Elizabeth Weiskopf
- Department of Pediatrics, Division of Stem Cell Transplant and Regenerative Medicine, Stanford University School of Medicine, Stanford, California
| | - Benjamin A Pinsky
- Department of Pathology, Stanford University School of Medicine, Stanford, California; Department of Medicine, Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, California
| | - Sandhya Kharbanda
- Department of Pediatrics, Division of Stem Cell Transplant and Regenerative Medicine, Stanford University School of Medicine, Stanford, California.
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13
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Lin CJ, Vader JM, Slade M, DiPersio JF, Westervelt P, Romee R. Cardiomyopathy in patients after posttransplant cyclophosphamide-based hematopoietic cell transplantation. Cancer 2017; 123:1800-1809. [DOI: 10.1002/cncr.30534] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 12/06/2016] [Accepted: 12/07/2016] [Indexed: 11/06/2022]
Affiliation(s)
- Chien-Jung Lin
- Division of Cardiovascular Medicine; Department of Medicine, Washington University School of Medicine; Saint Louis Missouri
| | - Justin M. Vader
- Division of Cardiovascular Medicine; Department of Medicine, Washington University School of Medicine; Saint Louis Missouri
| | - Michael Slade
- Bone Marrow Transplant and Leukemia Program; Department of Medicine, Washington University School of Medicine; Saint Louis Missouri
| | - John F. DiPersio
- Bone Marrow Transplant and Leukemia Program; Department of Medicine, Washington University School of Medicine; Saint Louis Missouri
| | - Peter Westervelt
- Bone Marrow Transplant and Leukemia Program; Department of Medicine, Washington University School of Medicine; Saint Louis Missouri
| | - Rizwan Romee
- Bone Marrow Transplant and Leukemia Program; Department of Medicine, Washington University School of Medicine; Saint Louis Missouri
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14
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Prognostic Factors on the Graft-versus-Host Disease-Free and Relapse-Free Survival after Adult Allogeneic Hematopoietic Stem Cell Transplantation. Stem Cells Int 2016; 2016:5143071. [PMID: 27123006 PMCID: PMC4829726 DOI: 10.1155/2016/5143071] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 02/12/2016] [Accepted: 02/25/2016] [Indexed: 11/21/2022] Open
Abstract
The cure of hematologic disorders by allogeneic hematopoietic stem cell transplantation (HSCT) is often associated with major complications resulting in poor outcome, including graft-versus-host disease (GVHD), relapse, and death. A novel composite endpoint of GVHD-free/relapse-free survival (GRFS) in which events include grades 3-4 acute GVHD, chronic GVHD requiring systemic therapy, relapse, or death is censored to completely characterize the survival without mortality or ongoing morbidity. In this regard, studies attempting to identify the prognostic factors of GRFS are quite scarce. Thus, we reviewed 377 adult patients undergoing allogeneic HSCT between 2003 and 2013. The 1- and 2-year GRFS were 40.8% and 36.5%, respectively, significantly worse than overall survival and disease-free survival (log-rank p < 0.001). European Group for Blood and Marrow Transplantation (EBMT) risk score > 2 (p < 0.001) and hematologic malignancy (p = 0.033) were poor prognostic factors for 1-year GRFS. For 2-year GRFS, EBMT risk score > 2 (p < 0.001), being male (p = 0.028), and hematologic malignancy (p = 0.010) were significant for poor outcome. The events between 1-year GRFS and 2-year GRFS predominantly increased in relapsed patients. With prognostic factors of GRFS, we could evaluate the probability of real recovery following HSCT without ongoing morbidity.
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15
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Acute pericarditis before engraftment in hematopoietic stem cell transplantation. Bone Marrow Transplant 2015; 51:459-61. [DOI: 10.1038/bmt.2015.282] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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16
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Chen X, Zou Q, Yin J, Wang C, Xu J, Wei J, Zhang Y. Pericardial effusion post transplantation predicts inferior overall survival following allo-hematopoietic stem cell transplant. Bone Marrow Transplant 2015; 51:303-6. [DOI: 10.1038/bmt.2015.227] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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17
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Acute pericarditis and tamponade from Coxsackie B3 in an adult Hematopoietic-Cell-Allograft recipient: A rare but potentially serious complication. Hematol Oncol Stem Cell Ther 2015; 9:82-5. [PMID: 26183671 DOI: 10.1016/j.hemonc.2015.06.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Revised: 05/25/2015] [Accepted: 06/07/2015] [Indexed: 11/20/2022] Open
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18
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Leonard JT, Newell LF, Meyers G, Hayes-Lattin B, Gajewski J, Heitner S, Nonas S, Allen B, Stentz A, Frires R, Maziarz RT, Holtan SG. Chronic GvHD-associated serositis and pericarditis. Bone Marrow Transplant 2015; 50:1098-104. [DOI: 10.1038/bmt.2015.105] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Revised: 03/20/2015] [Accepted: 03/25/2015] [Indexed: 11/09/2022]
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19
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Liu YC, Chien SH, Fan NW, Hu MH, Gau JP, Liu CJ, Yu YB, Liu CY, Hsiao LT, Liu JH, Chiou TJ, Tzeng CH. Risk factors for pericardial effusion in adult patients receiving allogeneic haematopoietic stem cell transplantation. Br J Haematol 2015; 169:737-45. [PMID: 25818840 DOI: 10.1111/bjh.13357] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Accepted: 01/20/2015] [Indexed: 01/22/2023]
Abstract
Pericardial effusion (PE) is a rare but potentially life-threatening complication for allogeneic haematopoietic stem cell transplantation (HSCT) recipients. The risk factors, aetiology, incidence and therapy are largely unclear. To investigate this issue, we reviewed 391 adult patients undergoing allogeneic HSCT between January 2003 and December 2013. Twelve out of 391 patients (3·1%) developed PE of moderate to large amounts, including 9 out of 12 patients (75%) identified as late-onset PE. Two out of the nine patients with late-onset PE experienced recurrent effusion. The median age at HSCT was 44·5 years (range: 22-63 years) among the 12 patients with PE and 47 years in the late-onset patients. Multivariate analysis revealed that multiple transplant procedures was a significant risk factor for PE (P = 0·036) and a trend as risk factor in patients aged>50 years (P = 0·066). For late-onset PE, pre-transplant age>50 years (P = 0·032) and extensive chronic graft-versus-host disease (cGVHD) (P = 0·006) remained statistically significant on multivariate analysis. Currently, there are no published data exploring the risk factors for post-transplant PE in adult patients of allogeneic HSCT. Our study determined the risk factors and incidence for the post-transplant PE, especially in the late-onset group.
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Affiliation(s)
- Yao-Chung Liu
- Department of Medicine of Yang-Ming Branch, Taipei City Hospital, Taipei, Taiwan.,Division of Haematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Sheng-Hsuan Chien
- Division of Haematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Nai-Wen Fan
- Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan.,Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ming-Hung Hu
- Division of Haematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan.,Department of Medicine, Cardinal Tien Hospital, Taipei, Taiwan
| | - Jyh-Pyng Gau
- Division of Haematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chia-Jen Liu
- Division of Haematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yuan-Bin Yu
- Division of Haematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chun-Yu Liu
- Division of Haematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Liang-Tsai Hsiao
- Division of Haematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Jin-Hwang Liu
- Division of Haematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Tzeon-Jye Chiou
- Division of Haematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Cheng-Hwai Tzeng
- Division of Haematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan
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20
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Yanagisawa R, Ishii E, Motoki N, Yamazaki S, Morita D, Sakashita K, Shiohara M, Tanaka M, Hidaka Y, Kubota N, Hidaka E, Ogiso Y, Nakamura T, Yasukochi S. Pretransplant-corrected QT dispersion as a predictor of pericardial effusion after pediatric hematopoietic stem cell transplantation. Transpl Int 2015; 28:565-74. [DOI: 10.1111/tri.12532] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2014] [Revised: 12/09/2014] [Accepted: 01/26/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Ryu Yanagisawa
- Division of Hematology/Oncology; Nagano Children's Hospital; Azumino Japan
- Department of Pediatrics; Shinshu University School of Medicine; Matsumoto Japan
| | - Eizaburo Ishii
- Department of Pediatrics; Nagano Prefectural Suzaka Hospital; Suzaka Japan
| | - Noriko Motoki
- Department of Pediatrics; Shinshu University School of Medicine; Matsumoto Japan
| | - Shoko Yamazaki
- Department of Pediatrics; Shinshu University School of Medicine; Matsumoto Japan
| | - Daisuke Morita
- Department of Pediatrics; Shinshu University School of Medicine; Matsumoto Japan
| | - Kazuo Sakashita
- Division of Hematology/Oncology; Nagano Children's Hospital; Azumino Japan
- Department of Pediatrics; Shinshu University School of Medicine; Matsumoto Japan
| | - Masaaki Shiohara
- Department of Pediatrics; School of Dentistry; Matsumoto Dental University; Shiojiri Japan
| | - Miyuki Tanaka
- Department of Pediatrics; Shinshu University School of Medicine; Matsumoto Japan
| | - Yoshihiko Hidaka
- Department of Pediatrics; Shinshu University School of Medicine; Matsumoto Japan
| | - Noriko Kubota
- Department of Laboratory Medicine; Nagano Children's Hospital; Azumino Japan
- Life Science Research Center; Nagano Children's Hospital; Azumino Japan
| | - Eiko Hidaka
- Department of Laboratory Medicine; Nagano Children's Hospital; Azumino Japan
- Life Science Research Center; Nagano Children's Hospital; Azumino Japan
| | - Yoshifumi Ogiso
- Division of Clinical Pathology; Nagano Children's Hospital; Azumino Japan
| | - Tomohiko Nakamura
- Division of Hematology/Oncology; Nagano Children's Hospital; Azumino Japan
- Life Science Research Center; Nagano Children's Hospital; Azumino Japan
| | - Satoshi Yasukochi
- Division of Pediatric Cardiology; Nagano Children's Hospital; Azumino Japan
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