1
|
Kong S, Nagraj S, Cooper DL, Ferrick KJ, Zhang L. A case report of fludarabine associated ectopic atrial bradycardia and literature review of fludarabine induced bradycardia. CARDIO-ONCOLOGY (LONDON, ENGLAND) 2024; 10:50. [PMID: 39123241 PMCID: PMC11312176 DOI: 10.1186/s40959-024-00253-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 07/29/2024] [Indexed: 08/12/2024]
Abstract
BACKGROUND Fludarabine is a chemotherapeutic agent with lymphodepleting effects that is increasingly used as part of a conditioning regimen prior to allogeneic stem cell transplantation. Fludarabine is generally considered a relatively safe medication with only rare cases of cardiotoxic side effects. CASE PRESENTATION Here, we present a case of a 30-year-old woman who was undergoing conditioning for a haploidentical cell transplantation for treatment of Fanconi anemia with a 5-day course of daily fludarabine infusion. After her second fludarabine infusion, she was noted to have ectopic atrial bradycardia that resolved with supportive therapy and completion of fludarabine infusion. CONCLUSION We report the first case of ectopic atrial bradycardia associated with fludarabine. Although rare and transient, clinicians should recognize this rare cardiotoxic side effect of fludarabine.
Collapse
Affiliation(s)
- Steve Kong
- Department of Medicine, NYC Health + Hospitals/North Central Bronx Hospital, Bronx, NY, USA.
| | - Sanjana Nagraj
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Dennis L Cooper
- Division of Oncology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Kevin J Ferrick
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Lili Zhang
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| |
Collapse
|
2
|
Çelik S, Güven ZT, Altınsoy A, Tubay ŞE, Keklik M, Ünal A. Fludarabine-induced bradycardia in allogeneic hematopoietic stem cell transplantation: A retrospective study. J Oncol Pharm Pract 2024; 30:860-866. [PMID: 37475474 DOI: 10.1177/10781552231189868] [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] [Indexed: 07/22/2023]
Abstract
INTRODUCTION Fludarabine, a purine analog, is getting more attention with the increasing use of reduced intensive conditioning regimens in allogeneic hematopoietic stem cell transplantation (allo-HSCT). The side effect of bradycardia was observed in only a few cases reported in the literature. In clinical practice, bradycardia can be asymptomatic or cause syncope and cardiac arrest. This study aimed to evaluate the bradycardia side effect of fludarabine used in the conditioning regimen in allo-HSCT recipients and to increase awareness of this issue. METHODS This retrospective study included 73 patients who received fludarabine in the allo-HSCT conditioning regimen between January 2015 and January 2021. Patients with and without bradycardia were compared regarding demographic data, allo-HSCT characteristics, electrolyte values, fludarabine administration dose and duration, and survival. Univariate and multivariate analyzes were performed to evaluate independent predictors for fludarabine-induced bradycardia. RESULTS Fludarabine administration doses and days were higher in the bradycardia group, but no statistically significant difference was observed. In the multivariate analysis, age was the only independent predictor of fludarabine-induced bradycardia (odds ratio (OR) 0.93, 95% confidence interval (CI): 0.89-0.98, p = 0.007). The median age in the group with bradycardia was 19 years younger than those without bradycardia (34 (19-49) vs 53 (19-69), p = 0.005). In 11 (84.6%) of the patients who had bradycardia, bradycardia improved with the discontinuation of fludarabine alone, but atropine was administered in 2 (15.4%) patients. CONCLUSION Age was the only independent predictor of fludarabine-induced bradycardia; therefore, close heart rate monitoring is recommended during fludarabine administration, especially in younger patients.
Collapse
Affiliation(s)
- Serhat Çelik
- Department of Hematology, Faculty of Medicine, Kırıkkale University, Kırıkkale, Türkiye
| | | | - Abdullah Altınsoy
- Department of Internal Medicine, Faculty of Medicine, Erciyes University, Kayseri, Türkiye
| | - Şaziye Esra Tubay
- Department of Clinical Pharmacy, Faculty of Pharmacy, Erciyes University, Kayseri, Türkiye
| | - Muzaffer Keklik
- Department of Hematology, Faculty of Medicine, Erciyes University, Kayseri, Türkiye
| | - Ali Ünal
- Department of Hematology, Faculty of Medicine, Erciyes University, Kayseri, Türkiye
| |
Collapse
|
3
|
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.
Collapse
|
4
|
LeMaistre FI, Tsai HL, Varadhan R, Al-Talib T, Jones R, Ambinder A. Allogeneic Hematopoietic Cell Transplantation with Non-Myeloablative Conditioning and Post-Transplant Cyclophosphamide Prophylaxis in Patients with Reduced Systolic Function. Transplant Cell Ther 2024; 30:208.e1-208.e7. [PMID: 37832717 DOI: 10.1016/j.jtct.2023.10.011] [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: 07/13/2023] [Revised: 09/16/2023] [Accepted: 10/09/2023] [Indexed: 10/15/2023]
Abstract
Post-transplantation cyclophosphamide (PTCy) has become standard of care for graft-versus-host disease (GVHD) prophylaxis after allogeneic hematopoietic cell transplantation (alloHCT), allowing for expanded donor options. However, there is scant literature examining outcomes of patients with reduced systolic function receiving PTCy. The present study aimed to describe our experience in performing alloHCT in patients with reduced systolic function, including their nonrelapse mortality (NRM), overall survival (OS), and cumulative incidence of early cardiac events (ECEs). We performed a retrospective descriptive analysis using the Johns Hopkins Hematologic Malignancy database. From 2017 through 2021, 1118 consecutive patients underwent alloHCT with nonmyeloablative (NMA) conditioning and PTCy. Forty-three of those patients had a pretransplantation left ventricular ejection fraction (LVEF) ≤45% measured by transthoracic echocardiography. Patients whose LVEF improved on treatment prior to transplantation were also included. These 2 cohorts were stratified into 2 groups-heart failure with reduced ejection fraction (HFrEF) and heart failure with recovered ejection fraction (HFrecEF)-and subgroup analyses compared NRM, OS, and cumulative incidence of ECEs, including arrhythmia, coronary artery disease, reduction in LVEF, and pericardial effusion, within 100 days post-transplantation. The median LVEF was 40% to 45% (range, 30% to 45%) for the 31 patients undergoing transplantation with HFrEF and 35% to 40% (range, 20% to 45%) for the 12 patients with HFrecEF. The NRM for all 43 patients was 16% (95% confidence interval [CI], 5% to 27%) at 100 days and 23% (95% CI, 11% to 36%) at 2 years. The NRM was 23% (95% CI, 8% to 38%) at 100 days and 26% (95% CI, 10% to 42%) at 2 years for the HFrEF cohort and 0 at 100 days and 18% (95% CI, 0 to 41%) at 2 years for the HFrecEf cohort. The OS at 3 years was 41% (95% CI, 26% to 62%), 40% (95% CI, 25% to 65%) and 38% (95% CI, 14% to 100%) in the combined, HFrEF, and HFrecEF cohorts, respectively. The cumulative incidence of any ECE was 37.2% (95% CI, 22% to 51.9%), including 39% of HFrEF subjects and 33% of HFrecEF subjects. Grade ≥3 toxicities were seen in 56% of patients. Reduced ejection fraction was the most common ECE. One death was attributable to a cardiac etiology. Cardiac toxicities seemed to be more frequent and severe in patients with a history of systolic dysfunction, but this did not lead to worse survival outcomes. This study adds to and extends the existing literature supporting the use of NMA conditioning and PTCy in patients with systolic dysfunction.
Collapse
Affiliation(s)
| | - Hua-Ling Tsai
- Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland
| | - Ravi Varadhan
- Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland
| | - Tala Al-Talib
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Richard Jones
- Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland
| | - Alexander Ambinder
- Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland.
| |
Collapse
|
5
|
Vasbinder A, Hoeger CW, Catalan T, Anderson E, Chu C, Kotzin M, Xie J, Kaakati R, Berlin HP, Shadid H, Perry D, Pan M, Takiar R, Padalia K, Mills J, Meloche C, Bardwell A, Rochlen M, Blakely P, Leja M, Banerjee M, Riwes M, Magenau J, Anand S, Ghosh M, Pawarode A, Yanik G, Nathan S, Maciejewski J, Okwuosa T, Hayek SS. Cardiovascular Events After Hematopoietic Stem Cell Transplant: Incidence and Risk Factors. JACC CardioOncol 2023; 5:821-832. [PMID: 38205002 PMCID: PMC10774793 DOI: 10.1016/j.jaccao.2023.07.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 07/13/2023] [Indexed: 01/12/2024] Open
Abstract
Background Hematopoietic stem cell transplantation (HSCT) is associated with various cardiovascular (CV) complications. Objectives We sought to characterize the incidence and risk factors for short-term and long-term CV events in a contemporary cohort of adult HSCT recipients. Methods We conducted a multicenter observational study of adult patients who underwent autologous or allogeneic HSCT between 2008 and 2019. Data on demographics, clinical characteristics, conditioning regimen, and CV outcomes were collected through chart review. CV outcomes were a composite of CV death, myocardial infarction, heart failure, atrial fibrillation/flutter, stroke, and sustained ventricular tachycardia and were classified as short-term (≤100 days post-HSCT) or long-term (>100 days post-HSCT). Results In 3,354 patients (mean age 55 years; 40.9% female; 30.1% Black) followed for a median time of 2.3 years (Q1-Q3: 1.0-5.4 years), the 100-day and 5-year cumulative incidences of CV events were 4.1% and 13.9%, respectively. Atrial fibrillation/flutter was the most common short- and long-term CV event, with a 100-day incidence of 2.6% and a 5-year incidence of 6.8% followed by heart failure (1.1% at 100 days and 5.4% at 5 years). Allogeneic recipients had a higher incidence of long-term CV events compared to autologous recipients (5-year incidence 16.4% vs 12.1%; P = 0.002). Baseline CV comorbidities were associated with a higher risk of long-term CV events. Conclusions The incidence of short-term CV events in HSCT recipients is relatively low. Long-term events were more common among allogeneic recipients and those with pre-existing CV comorbidities.
Collapse
Affiliation(s)
- Alexi Vasbinder
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Christopher W. Hoeger
- Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Tonimarie Catalan
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Elizabeth Anderson
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Catherine Chu
- Rush Medical College, Rush University, Chicago, Illinois, USA
| | - Megan Kotzin
- Rush Medical College, Rush University, Chicago, Illinois, USA
| | - Jeffrey Xie
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Rayan Kaakati
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Hanna P. Berlin
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Husam Shadid
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Daniel Perry
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Michael Pan
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Radhika Takiar
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Kishan Padalia
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Jamie Mills
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Chelsea Meloche
- Division of Cardiovascular Medicine, Texas Heart Institute, Houston, Texas, USA
| | - Alina Bardwell
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Matthew Rochlen
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Pennelope Blakely
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Monika Leja
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Mousumi Banerjee
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Mary Riwes
- Division of Hematology/Oncology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - John Magenau
- Division of Hematology/Oncology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Sarah Anand
- Division of Hematology/Oncology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Monalisa Ghosh
- Division of Hematology/Oncology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Attaphol Pawarode
- Division of Hematology/Oncology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Gregory Yanik
- Division of Hematology/Oncology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Sunita Nathan
- Division of Hematology, Oncology and Cell Therapy, Department of Internal Medicine, Rush Medical College, Chicago, Illinois, USA
| | - John Maciejewski
- Division of Hematology/Oncology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Tochukwu Okwuosa
- Division of Cardiology, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Salim S. Hayek
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| |
Collapse
|
6
|
Gerhartz B, Damodharan S, Puccetti DM, Boriosi JP, Hokanson JS, Capitini CM. Use of milrinone to support therapy-induced heart failure through hematopoietic stem cell transplantation in a pediatric patient with high-risk FLT3+ acute myeloid leukemia. Pediatr Blood Cancer 2023; 70:e30542. [PMID: 37485552 DOI: 10.1002/pbc.30542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 06/25/2023] [Indexed: 07/25/2023]
Affiliation(s)
- Brianna Gerhartz
- Department of Pediatrics, University of Wisconsin School of Medicine & Public Health, Madison, Wisconsin, USA
| | - Sudarshawn Damodharan
- Department of Pediatrics, University of Wisconsin School of Medicine & Public Health, Madison, Wisconsin, USA
- Division of Pediatric Hematology, Oncology and Bone Marrow Transplant, University of Wisconsin School of Medicine & Public Health, Madison, Wisconsin, USA
| | - Diane M Puccetti
- Department of Pediatrics, University of Wisconsin School of Medicine & Public Health, Madison, Wisconsin, USA
- Division of Pediatric Hematology, Oncology and Bone Marrow Transplant, University of Wisconsin School of Medicine & Public Health, Madison, Wisconsin, USA
| | - Juan P Boriosi
- Division of Pediatric Critical Care Medicine, University of Wisconsin School of Medicine & Public Health, Madison, Wisconsin, USA
| | - John S Hokanson
- Division of Pediatric Cardiology, University of Wisconsin School of Medicine & Public Health, Madison, Wisconsin, USA
| | - Christian M Capitini
- Department of Pediatrics, University of Wisconsin School of Medicine & Public Health, Madison, Wisconsin, USA
- Division of Pediatric Hematology, Oncology and Bone Marrow Transplant, University of Wisconsin School of Medicine & Public Health, Madison, Wisconsin, USA
- Carbone Cancer Center, University of Wisconsin, Madison, Wisconsin, USA
| |
Collapse
|
7
|
Tamburacı Uslu ZD, Ekici F, Yalçın K, Küpesiz A, Güler E, Dönmez L. The serial changes in myocardial functions after paediatric haematopoietic stem cell transplantation. Cardiol Young 2023; 33:1606-1613. [PMID: 36102124 DOI: 10.1017/s1047951122002712] [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: 11/06/2022]
Abstract
The aim of this study is to evaluate the changes in myocardial functions in children who underwent haematopoietic stem cell transplantation along with associated chemotherapy. Additionally, we evaluated the effect of baseline echocardiographic parameters on mortality. We evaluated 39 patients (mean age 7.4 years) who underwent haematopoietic stem cell transplantation owing to non-malignant disease. The control group included 39 healthy children who had normal cardiac findings. The myocardial functions were evaluated in all subjects by conventional echocardiography and tissue Doppler echocardiography before haematopoietic stem cell transplantation and in the 1st, 3rd, 6th, and 12th month after haematopoietic stem cell transplantation. All patients had normal left ventricular ejection fraction before haematopoietic stem cell transplantation, except one case. Before haematopoietic stem cell transplantation, the patient group had significantly greater mean pulmonary artery pressure and lower tricuspid valve annular plane excursion rate. Baseline E' velocities for mitral lateral annuli, septum, and tricuspid lateral annuli were lower in the patient group than the control group. The E' velocities for the left ventricle decreased in the patient group after haematopoietic stem cell transplantation, and then returned to baseline levels at the 6 months. E' and S' velocities for tricuspid lateral annuli also decreased after haematopoietic stem cell transplantation and were still depressed in the first year after haematopoietic stem cell transplantation. Baseline E' velocity for septum was significantly lower in patients who died after haematopoietic stem cell transplantation than patients who survived (p = 0.009). Subclinical impairment in both ventricular functions was observed after haematopoietic stem cell transplantation and the right ventricular functions were affected for longer periods than left ventricle after haematopoietic stem cell transplantation. The myocardial functions should be monitored after the first year of haematopoietic stem cell transplantation.
Collapse
Affiliation(s)
| | - Filiz Ekici
- Pediatric Cardiology, Akdeniz University Hospital, Antalya, Turkey
| | - Koray Yalçın
- Pediatric Hematology, Akdeniz University Hospital, Antalya, Turkey
| | - Alphan Küpesiz
- Pediatric Hematology, Akdeniz University Hospital, Antalya, Turkey
| | - Elif Güler
- Pediatric Hematology, Akdeniz University Hospital, Antalya, Turkey
| | - Levent Dönmez
- Public Health, Akdeniz University Medicine Faculty, Antalya, Turkey
| |
Collapse
|
8
|
Aghel N, Lui M, Wang V, Khalaf D, Mian H, Hillis C, Walker I, Leber B, Lipton JH, Aljama M, Lepic K, Berg T, Garcia-Horton A, Petropoulos J, Masoom H, Leong DP. Cardiovascular events among recipients of hematopoietic stem cell transplantation-A systematic review and meta-analysis. Bone Marrow Transplant 2023; 58:478-490. [PMID: 36849807 DOI: 10.1038/s41409-023-01928-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 01/17/2023] [Accepted: 01/20/2023] [Indexed: 03/01/2023]
Abstract
Cardiovascular diseases are an emerging cause of mortality and morbidity in survivors of hematopoietic stem cell transplantation (HSCT); however, the incidence of cardiovascular events (CVEs) in this population is not well described. This systematic review summarizes the evidence on the incidence of CVEs in HSCT recipients. Medline and Embase were searched from inception to December 2020. Inclusion criteria were cohort studies and phase 3 randomized controlled trials that reported CVEs among adults who underwent HSCT for hematological malignancies. After reviewing 8386 citations, 57 studies were included. The incidence of CVEs at 100 days was 0.19 (95% CI: 0.17-0.21) per 100 person-days after autologous HSCT and 0.06 (95% CI: 0.05-0.07) per 100 person-days after allogeneic HSCT. This higher incidence after autologous HSCT was driven by reports of arrhythmia from one population-based study in patients with multiple myeloma. The incidence of long-term CVEs was 3.98 (95% CI; 3.44-4.63) per 1000 person-years in survivors of autologous HSCT and 3.06 (95% CI; 2.69-3.48) per 1000 person-years in survivors of allogeneic HSCT. CVEs remain an important but under-reported cause of morbidity and mortality in recipients of HSCT. Future studies are required to better understand the incidence and risk factors for CVEs in HSCT recipients.
Collapse
Affiliation(s)
- N Aghel
- Division of Cardiology, Cardio-Oncology Program, McMaster University, and Population Health Research Institute Hamilton, Hamilton, ON, Canada.
| | - M Lui
- Department of Pharmacy, Hamilton Health Sciences, Hamilton, ON, Canada
| | - V Wang
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - D Khalaf
- Department of Hematology, McMaster University, Hamilton, ON, Canada
| | - H Mian
- Department of Oncology, McMaster University, Hamilton, ON, Canada
| | - C Hillis
- Department of Hematology, McMaster University, Hamilton, ON, Canada
| | - I Walker
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - B Leber
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - J H Lipton
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - M Aljama
- Department of Oncology, McMaster University, Hamilton, ON, Canada
| | - K Lepic
- Department of Hematology, McMaster University, Hamilton, ON, Canada
| | - T Berg
- Department of Oncology, McMaster University, Hamilton, ON, Canada
| | - A Garcia-Horton
- Department of Oncology, McMaster University, Hamilton, ON, Canada
| | - J Petropoulos
- Health Sciences Library, McMaster University, Hamilton, ON, Canada
| | - H Masoom
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - D P Leong
- Division of Cardiology, Cardio-Oncology Program, McMaster University, and Population Health Research Institute Hamilton, Hamilton, ON, Canada
| |
Collapse
|
9
|
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.
Collapse
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.
| |
Collapse
|
10
|
Leiva O, Bohart I, Ahuja T, Park D. Off-Target Effects of Cancer Therapy on Development of Therapy-Induced Arrhythmia: A Review. Cardiology 2023; 148:324-334. [PMID: 36702116 PMCID: PMC10614257 DOI: 10.1159/000529260] [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] [Received: 12/02/2022] [Accepted: 01/17/2023] [Indexed: 01/27/2023]
Abstract
BACKGROUND Advances in cancer therapeutics have improved overall survival and prognosis in this patient population; however, this has come at the expense of cardiotoxicity including arrhythmia. SUMMARY Cancer and its therapies are associated with cardiotoxicity via several mechanisms including inflammation, cardiomyopathy, and off-target effects. Among cancer therapies, anthracyclines and tyrosine kinase inhibitors (TKIs) are particularly known for their pro-arrhythmia effects. In addition to cardiomyopathy, anthracyclines may be pro-arrhythmogenic via reactive oxygen species (ROS) generation and altered calcium handling. TKIs may mediate their cardiotoxicity via inhibition of off-target tyrosine kinases. Ibrutinib-mediated inhibition of CSK may be responsible for the increased prevalence of atrial fibrillation. Further investigation is warranted to further elucidate the mechanisms behind arrhythmias in cancer therapies. KEY MESSAGES Arrhythmias are a common cardiotoxicity of cancer therapies. Cancer therapies may induce arrhythmias via off-target effects. Understanding the mechanisms underlying arrhythmogenesis associated with cancer therapies may help design cancer therapies that can avoid these toxicities.
Collapse
Affiliation(s)
- Orly Leiva
- Division of Cardiology, Department of Medicine, New York University Grossman School of Medicine, New York City, New York, USA
| | - Isaac Bohart
- Division of Cardiology, Department of Medicine, New York University Grossman School of Medicine, New York City, New York, USA
| | - Tania Ahuja
- Division of Cardiology, Department of Medicine, New York University Grossman School of Medicine, New York City, New York, USA
| | - David Park
- Division of Cardiology, Department of Medicine, New York University Grossman School of Medicine, New York City, New York, USA
| |
Collapse
|
11
|
Auberle C, Lenihan D, Gao F, Cashen A. Late cardiac events after allogeneic stem cell transplant: incidence, risk factors, and impact on overall survival. CARDIO-ONCOLOGY (LONDON, ENGLAND) 2023; 9:1. [PMID: 36604733 PMCID: PMC9817299 DOI: 10.1186/s40959-022-00150-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 12/26/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND There is limited data on the impact of cardiac disease on long term outcomes of allogeneic stem cell transplant (alloSCT). Our study aims to describe the incidence of late cardiac events after alloSCT, identify risk factors for developing a late cardiac event, and illustrate the impact of late cardiac events on overall survival. METHODS Patients who underwent alloSCT from 2007 to 2017 and survived more than 1 year after transplant (N = 804) were included. Gray's sub-distribution methods, while accounting for death as a competing risk, were used to calculate the cumulative incidence of late cardiac events. Univariate regression models based on Gray's sub-distribution were fitted to assess the potential predictive effects of baseline characteristics on the risk of developing any late cardiac events. Univariate Cox proportional hazard regression models were used to evaluate the association between late cardiac events and overall survival. RESULTS The cumulative incidence of a late cardiac event at 5 years after transplant was 22% (95% CI 19-25%). The most frequent cardiac event was a decline in LVEF to < 45% with a cumulative incidence of 9% (95% CI 7-11%). Patients were at significantly increased hazard of developing a late cardiac event if they had a history of congestive heart failure prior to alloSCT (HR 4.53, 95% CI 2.57-7.97, p-value < 0.001), a decline in LVEF to < 45% (HR 3.95, 95% CI 2.09-7.47, p-value < 0.001) or cerebral vascular accident (HR 3.13, 95% CI 1.38-7.06, p-value 0.004). Transplant characteristics such as primary disease, donor type, use of TBI, myeloablative conditioning regimen or tyrosine kinase inhibitor had no significant association with late cardiac events. Almost all cardiac events demonstrated a significantly increased risk of death. This hazard was the highest in patients who experienced an atrial arrhythmia (HR 10.6, 95% CI 7.7-14.6). CONCLUSION Adverse cardiac events are relatively common late after alloSCT with identifiable risk factors such as medical comorbidities prior to transplant and are associated with a negative impact on overall survival.
Collapse
Affiliation(s)
- Christine Auberle
- Washington University School of Medicine, 660 South Euclid Avenue, Box 8056, St. Louis, MO, 63110, USA.
| | - Daniel Lenihan
- International Cardio-Oncology Society, Tampa, FL, USA
- St. Francis Healthcare, Cape Girardeau, MO, USA
| | - Feng Gao
- Washington University School of Medicine, 660 South Euclid Avenue, Box 8056, St. Louis, MO, 63110, USA
| | - Amanda Cashen
- Washington University School of Medicine, 660 South Euclid Avenue, Box 8056, St. Louis, MO, 63110, USA
| |
Collapse
|
12
|
Alizadehasl A, Ghadimi N, Hosseinifard H, Roudini K, Emami AH, Ghavamzadeh A, Khoda-Amorzideh D. Cardiovascular diseases in patients after hematopoietic stem cell transplantation: Systematic review and Meta-analysis. Curr Res Transl Med 2023; 71:103363. [PMID: 36427416 DOI: 10.1016/j.retram.2022.103363] [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: 04/27/2022] [Revised: 08/02/2022] [Accepted: 08/27/2022] [Indexed: 02/06/2023]
Abstract
BACKGROUND Hematopoietic Stem Cell Transplantation (HSCT), is performed to treat many malignancies such as autologous or allogenic. Despite the success of this method in treating patients, - sometimes some HSCT recipients face problems such as cardiovascular complications. Therefore, this systematic review and meta-analysis aimed to evaluate the prevalence of cardiovascular complications in post-transplant patients. METHOD In order to review the published studies, we examined PubMed, MEDLINE, Cochrane Library, Scopus, and web of science databases from the beginning to the end of January 2022, and we used tools by the Newcastle-Ottawa Scale to evaluate the quality of the studies. RESULT In this study, 37 articles were included in the meta-analysis and 30,957 patients were examined. Also, the mean age of patients was 35.37 years. Based on the results of the meta-analysis, the prevalence of cardiovascular disease (CVD), was 16.84%. In addition, other complications related to CVD which include Arrhythmias, Congestive Heart Failure (CHF), Hypertension, stroke, and mortality were examined in patients who had hematopoietic stem cell transplantation and the resulting amounts were 3.91%, 3.66, 17.71, 0.22%, and 1.53%, respectively. CONCLUSION This study showed that the prevalence of cardiovascular disease after hematopoietic stem cell transplantation is high and needs special attention.
Collapse
Affiliation(s)
- Azin Alizadehasl
- Cardio-Oncology Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Nashmil Ghadimi
- Cardio-Oncology Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Hossein Hosseinifard
- Research Center for evidence-based medicine (rcebm), Tabriz University of Medical Sciences, Tabriz, Iran
| | - Kamran Roudini
- Department of internal medicine, Hematology and Medical oncology ward, Cancer research center, cancer institute, Imam Khomeini hospital complex, Tehran University of medical sciences, Tehran, Iran, Islamic republic of Iran
| | - Amir Hossein Emami
- Department of internal Medicine, school of medicine cancer institute, Imam Khomeini Hospital Tehran University of Medical Sciences
| | - Ardeshir Ghavamzadeh
- Cancer & cell Therapy Research Center, Tehran University of medical Scinces Tehran
| | - Davood Khoda-Amorzideh
- Cardio-Oncology Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.
| |
Collapse
|
13
|
Cardiovascular Complications in Hematopoietic Stem Cell Transplanted Patients. J Pers Med 2022; 12:jpm12111797. [PMID: 36579521 PMCID: PMC9692512 DOI: 10.3390/jpm12111797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 10/16/2022] [Accepted: 10/24/2022] [Indexed: 11/06/2022] Open
Abstract
Hematopoietic stem cell transplantation (HSCT) is the only curative treatment for many patients suffering from hematologic malignancies, solid tumors, inborn errors of metabolism or genetic disorders. Despite decades of successful HSCT, clinical outcomes are still far from satisfactory due to treatment-related complications, including graft-versus-host disease (GvHD) and cardiovascular complications (CVC). CVC may affect patients in the acute period post-HSCT; however, the occurrence is far higher among long-term survivors. Induction treatment using cardiotoxic treatments, e.g., anthracyclines and radiotherapy, conditioning regimens containing cyclophosphamide, and post-HSCT comorbidities, including GvHD, are factors contributing to CVC. Cardiac function evaluation prior to and post-transplantation is an important strategy for choosing the proper conditioning regimen, HSCT protocol and post-HSCT supportive care. Cardiac systolic function evaluation by echocardiography, in addition to serum cardiac biomarkers, such as troponins and brain natriuretic peptides, is recommended as a routine follow-up for HSCT patients. Angiotensin-converting enzyme inhibitors, angiotensin-II-receptor blockers, and beta-blockers, which are mostly used for the treatment of chemotherapy-induced cardiotoxicity, might be used as treatments for HSCT-related CVC. In summary, the present review reveals the urgent need for further investigations concerning HSCT-related CVC both at the preclinical and clinical levels due to the lack of knowledge about CVC and its underlying mechanisms.
Collapse
|
14
|
Dillon HT, Saner NJ, Ilsley T, Kliman D, Spencer A, Avery S, Dunstan DW, Daly RM, Fraser SF, Owen N, Lynch BM, Kingwell BA, La Gerche A, Howden EJ. Preventing the adverse cardiovascular consequences of allogeneic stem cell transplantation with a multi-faceted exercise intervention: the ALLO-Active trial protocol. BMC Cancer 2022; 22:898. [PMID: 35978289 PMCID: PMC9383666 DOI: 10.1186/s12885-022-09793-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 06/17/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Allogeneic stem cell transplantation (allo-SCT) is a potentially lifesaving treatment for high-risk hematological malignancy, but survivors experience markedly elevated rates of cardiovascular disease and associated functional impairment. Mounting evidence suggests regular exercise, combined with a reduction in sedentary time through replacement with light exercise may be a useful therapeutic strategy for the prevention of cardiovascular comorbidities. However, this type of intervention has yet to be evaluated in patients undergoing allo-SCT. The ALLO-Active study will evaluate the efficacy of a ~ 4 month multi-faceted exercise intervention, commenced upon admission for allo-SCT, to preserve peak oxygen uptake (VO2peak) and peak cardiac output, compared with usual care. The study will also evaluate the effect of the intervention on functional independence, quality of life, and symptoms of fatigue. METHODS Sixty adults with hematological malignancy scheduled for allo-SCT will be randomly assigned to usual care (n = 30) or the exercise and sedentary behaviour intervention (n = 30). Participants assigned to the intervention will complete a thrice weekly aerobic and progressive resistance training program and concomitantly aim to reduce daily sedentary time by 30 min with short, frequent, light-intensity exercise bouts. Participants will undergo testing prior to, immediately after inpatient discharge, and 12 weeks after discharge. To address aim 1, VO2peak and peak cardiac output (multiple primary outcomes, p < 0.025) will be assessed via cardiopulmonary exercise testing and exercise cardiac magnetic resonance imaging, respectively. Secondary outcomes include functional independence (defined as VO2peak ≥ 18.mL.kg-1.min-1), quality of life, and fatigue (assessed via validated questionnaire). Exploratory outcomes will include indices of resting cardiac, vascular, and skeletal muscle structure and function, cardiovascular biomarkers, anxiety and depression, transplant outcomes (e.g., engraftment, graft-versus-host disease), and habitual physical activity, sedentary time, and sleep. DISCUSSION Multi-faceted exercise programs are a promising approach for ameliorating the cardiovascular consequences of allo-SCT. If this intervention proves to be effective, it will contribute to the development of evidence-based exercise guidelines for patients undergoing allo-SCT and assist with optimising the balance between acute cancer management and long-term health. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry (ANZCTR), ID: 12619000741189 . Registered 17 May 2019.
Collapse
Affiliation(s)
- Hayley T Dillon
- Baker Heart and Diabetes Institute, Melbourne, Australia.
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia.
| | | | - Tegan Ilsley
- Baker Heart and Diabetes Institute, Melbourne, Australia
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - David Kliman
- Malignant Haematology and Stem Cell Transplantation Service, Alfred Hospital, Melbourne, Australia
| | - Andrew Spencer
- Malignant Haematology and Stem Cell Transplantation Service, Alfred Hospital, Melbourne, Australia
| | - Sharon Avery
- Malignant Haematology and Stem Cell Transplantation Service, Alfred Hospital, Melbourne, Australia
| | - David W Dunstan
- Baker Heart and Diabetes Institute, Melbourne, Australia
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
| | - Robin M Daly
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Steve F Fraser
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Neville Owen
- Baker Heart and Diabetes Institute, Melbourne, Australia
- Centre for Urban Transitions, Swinburne University of Technology, Melbourne, Australia
| | - Brigid M Lynch
- Baker Heart and Diabetes Institute, Melbourne, Australia
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Parkville, Australia
| | - Bronwyn A Kingwell
- Baker Heart and Diabetes Institute, Melbourne, Australia
- CSL Ltd, Melbourne, Australia
| | | | - Erin J Howden
- Baker Heart and Diabetes Institute, Melbourne, Australia
| |
Collapse
|
15
|
Cardiac complications associated with hematopoietic stem-cell transplantation. Bone Marrow Transplant 2021; 56:2637-2643. [PMID: 34381168 DOI: 10.1038/s41409-021-01427-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 07/21/2021] [Accepted: 07/27/2021] [Indexed: 12/11/2022]
Abstract
Advances in chemotherapy and supportive therapy have resulted in improved clinical outcomes in patients with hematological malignancies undergoing hematopoietic stem-cell transplantation (HSCT). However, the association between HSCT and early- and late-onset cardiotoxicity remains controversial as these cardiac complications, including acute heart failure and arrhythmia, such as atrial fibrillation, can occasionally be lethal. Although the overall pathophysiology has not been elucidated, initial/salvage chemotherapy before HSCT, such as anthracycline-combined regimens, conditioning regimens, thoracic radiotherapy, and pre-existing personal risk factors, could be associated with an increased risk of cardiac events. Routine monitoring of cardiac function using global longitudinal strain or left ventricular ejection fraction in echocardiogram and serum biomarkers could be an option to detect early changes in cardiac status before irreversible cardiac complications develop. While beta-blockers and angiotensin-converting enzyme inhibitors are commonly used for cardioprotection, their clinical benefit has not been fully established in HSCT-associated cardiotoxicity. In the future, genetic analysis to reveal individual vulnerability to cardiotoxicity and prospective trials assessing the clinical benefit of early interventions, including novel agents such as angiotensin receptor-neprilysin inhibitor, are warranted. Collaboration between oncologists and cardiologists is crucial to establishing a strategy to prevent cardiac complications.
Collapse
|
16
|
Rotz SJ, Ryan TD, Hayek SS. Cardiovascular disease and its management in children and adults undergoing hematopoietic stem cell transplantation. J Thromb Thrombolysis 2021; 51:854-869. [PMID: 33230704 PMCID: PMC8085022 DOI: 10.1007/s11239-020-02344-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/12/2020] [Indexed: 02/07/2023]
Abstract
Hematopoietic stem cell transplantation (HSCT) is a potentially curative treatment for many malignancies, hemoglobinopathies, metabolic diseases, bone marrow failure syndromes, and primary immune deficiencies. Despite the significant improvement in survival afforded by HSCT, the therapy is associated with major short and long-term morbidity and mortality. Cardiovascular complications such as cardiomyopathy, arrhythmias, pulmonary hypertension, and pericardial effusions are increasingly recognized as potential outcomes following HSCT. The incidence of cardiac complications is related to various factors such as age, co-morbid medical conditions, whether patients received cardiotoxic chemotherapy prior to HSCT, the type of HSCT (autologous versus allogeneic), and the specific conditioning regimen. Thus, the cardiovascular evaluation has become a core component of the pre-transplant assessment, however, the practice differs from center to center as national guidelines and contemporary high-quality studies are lacking. We review the incidence of cardiotoxicity in pediatric and adult HSCT, potential mechanisms of injury, and effects on long-term outcomes. We also discuss the possible therapeutic approaches when disease arises, as well as the indications and need for surveillance before, during, and after transplantation.
Collapse
Affiliation(s)
- Seth J Rotz
- Department of Pediatric Hematology, Oncology, and Blood and Marrow Transplantation, Pediatric Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, 44195, USA.
| | - Thomas D Ryan
- Department of Pediatrics, University of Cincinnati College of Medicine, and Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Salim S Hayek
- Division of Cardiology, Department of Medicine, University of Michigan, Ann Arbor, MI, USA
| |
Collapse
|
17
|
Cardiovascular Issues in Hematopoietic Stem Cell Transplantation (HSCT). Curr Treat Options Oncol 2021; 22:51. [PMID: 33939030 DOI: 10.1007/s11864-021-00850-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2021] [Indexed: 12/28/2022]
Abstract
OPINION STATEMENT Hematopoietic stem cell transplantation (HSCT) is considered, since 1957, a potentially curative therapeutic option for many hemopathies. Although it is an aggressive procedure, improvements in transplantation techniques and supportive strategies have markedly decreased treatment-related mortality, and the prevalence of HSCT survivors is expected to exceed half a million by 2030. At the same time, there is a growing awareness of the potentially negative effects of HSCT-related therapies on the cardiovascular (CV) system, and HSCT survivors constitute a population at high cardiovascular (CV) risk. Cardio-oncology has been proposed as a new approach to prevent cardiovascular toxicity during and after HSCT. The present article attempts to provide a multidisciplinary and practical approach to the prevention, monitoring, and management of the most common cardiovascular complications in patients undergoing hematopoietic stem cell transplantation.
Collapse
|
18
|
Oliveira GH, Al-Kindi SG, Guha A, Dey AK, Rhea IB, deLima MJ. Cardiovascular risk assessment and management of patients undergoing hematopoietic cell transplantation. Bone Marrow Transplant 2020; 56:544-551. [PMID: 33130819 DOI: 10.1038/s41409-020-01080-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 09/18/2020] [Accepted: 09/29/2020] [Indexed: 01/07/2023]
Abstract
The purpose of this review is to provide a framework for the cardiovascular evaluation and management of patients undergoing hematopoietic cell transplantation (HCT). To accomplish this, we have performed an extensive literature review, critically analyzed the available evidence, and developed a set of recommendations to guide best practice. Herein, we discuss the cardiovascular risk profile of patients undergoing HCT along with putative mechanisms of HCT-induced cardiovascular injury. We then present an algorithm for cardiovascular testing and risk mitigation of potential recipients. Last, we address the management of the most prevalent cardiovascular conditions associated with HCT recipients.
Collapse
Affiliation(s)
- Guilherme H Oliveira
- Heart and Vascular Institute, University of South Florida, Tampa General Hospital and Moffitt Cancer Center, Tampa, FL, USA.
| | - Sadeer G Al-Kindi
- University Hospitals Cleveland Medical Center, Cleveland, OH, USA.,Department of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Avirup Guha
- University Hospitals Cleveland Medical Center, Cleveland, OH, USA.,Department of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Amit K Dey
- National Heart, Lung and Blood Institute, Bethesda, MD, USA
| | - Isaac B Rhea
- Division of Cardiovascular Diseases, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Marcos J deLima
- Department of Medicine, Case Western Reserve University, Cleveland, OH, USA.,Stem Cell Transplant Program, Seidman Cancer Center, Cleveland, OH, USA
| |
Collapse
|
19
|
Fornwalt RA, Brigham EP, Scott Stephens R. Critical Care of Hematopoietic Stem Cell Transplant Patients. Crit Care Clin 2020; 37:29-46. [PMID: 33190774 DOI: 10.1016/j.ccc.2020.08.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Life-threatening complications are frequent after hematopoietic stem cell transplant (HSCT), and optimum critical care is essential to ensuring good outcomes. The immunologic consequences of HSCT result in a markedly different host response to critical illness. Infection is the most common cause of critical illness but noninfectious complications are frequent. Respiratory failure or sepsis are the typical presentations but the sequelae of HSCT can affect nearly any organ system. Pattern recognition can facilitate anticipation and early intervention in post-HSCT critical illness. HSCT critical care is a multidisciplinary endeavor. Continued investigation and focus on process improvement will continue to improve outcomes.
Collapse
Affiliation(s)
- Rachael A Fornwalt
- Oncology Intensive Care Unit, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins Hospital, Harry and Jeanette Weinberg Building, Pod 5C, 401 North Broadway, Baltimore, MD 21231, USA
| | - Emily P Brigham
- Oncology Intensive Care Unit, Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University, 1830 East Monument Street, 5th Floor, Baltimore, MD 21205, USA
| | - R Scott Stephens
- Oncology Intensive Care Unit, Division of Pulmonary and Critical Care Medicine, Departments of Medicine and Oncology, Johns Hopkins University, 1800 Orleans Street, Suite 9121 Zayed Tower, Baltimore, MD 21287, USA.
| |
Collapse
|
20
|
Ayuna A, Stepien KM, Hendriksz CJ, Balerdi M, Garg A, Woolfson P. Cardiac rhythm abnormalities - An underestimated cardiovascular risk in adult patients with Mucopolysaccharidoses. Mol Genet Metab 2020; 130:133-139. [PMID: 32241717 DOI: 10.1016/j.ymgme.2020.03.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 03/25/2020] [Accepted: 03/25/2020] [Indexed: 11/16/2022]
Abstract
Patients with Mucopolysaccharidosis (MPS) have an increased risk of cardiovascular complications, conduction tissue abnormalities and arrhythmia; all rare but underestimated. It has been reported that conduction system defects are progressive in this group of patients and may result in sudden cardiac death. The aim of this study is to review our current practice and suggest best practice guidelines regarding the frequency of cardiac rhythm monitoring in this patient group. Seventy-seven adult MPS patients who attended metabolic clinics between 2013 and 2019 were included in this retrospective observational study. Patients were affected with different MPS types: MPS I (n = 33), MPS II (n = 16), MPS IV (n = 19), VI (n = 8) and VII (n = 1). The assessments included: 12‑lead electrocardiogram (ECG), 24-h ECG (Holter monitor), loop recorder/pacemaker interrogation assessment. Data from 12‑lead ECG (available from 69 patients) showed a variety of abnormalities: T wave inversion in a single lead III (n = 19), left ventricular hypertrophy (n = 14), early repolarization (n = 14), right axis deviation (RAD, n = 11), partial RBBB (n = 9), right bundle branch block (RBBB) (n = 1) and first degree AV block (n = 1). ECG changes of bundle branch block, RAD (left posterior fascicular block) could represent conduction tissue abnormality and equally could be related to the underlying lung tissue abnormality which is present in most of the patients with MPS. T wave abnormality in a single lead is usually insignificant in healthy individuals; however in MPS patients it could be as a result of chest shape. Among the 34 patients for who 24-hour ECG was available, sinus tachycardia was the most common rhythm noted (n = 9), followed by sinus bradycardia (n = 4), atrial fibrillation (AF) (n = 1) and atrio-ventricular nodal re-entry tachycardia (AVNRT) (n = 1). Permanent pacemaker was inserted in two patients. AF was observed in one patient with MPS II. In conclusion, we postulate that regular cardiac monitoring is required to warrant early detection of underlying conduction tissue abnormalities. In addition, 12‑lead ECG is the first line investigation that, if abnormal, should be followed up by 24-hour Holter monitoring. These findings warrant further research studies.
Collapse
Affiliation(s)
- Ahmed Ayuna
- Cardiology Department, Salford Royal NHS Foundation Trust, Salford, United Kingdom
| | - Karolina M Stepien
- Adult Inherited Metabolic Medicine Department, Salford Royal NHS Foundation Trust, Salford, M6 8HD, United Kingdom.
| | | | - Matthew Balerdi
- Cardiology Department, Hull and East Yorkshire Hospitals and Northern Lincolnshire and Goole Hospitals, United Kingdom
| | - Anupam Garg
- Cardiology Department, Royal United Hospitals Bath NHS Foundation Trust, Bath, United Kingdom
| | - Peter Woolfson
- Cardiology Department, Salford Royal NHS Foundation Trust, Salford, United Kingdom
| |
Collapse
|
21
|
Aladag E, Demiroglu H, Buyukasik Y, Karakulak UN, Tekin F, Aksu S, Goker H. Cardiac adverse events during stem cell transplantation for hematological malignancies: A single centre experience. Transfus Apher Sci 2020; 59:102653. [PMID: 32088113 DOI: 10.1016/j.transci.2019.09.006] [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: 07/02/2019] [Revised: 09/02/2019] [Accepted: 09/07/2019] [Indexed: 10/25/2022]
Abstract
Hematopoietic stem cell transplantation (HSCT) is a highly successful treatment option for many hematological malignancies. Several adverse effects can be seen in HSCT due to the infusion and damage caused by the conditioning regimens. Cardiovascular adverse effects are relatively common during HSCT, and they have the potential to cause devastating complications. The aim of present study was to evaluate the transplantation-related cardiac adverse effects and determine the risk factors in patients undergoing HSCT at our institution. A retrospective analysis has been performed in 662 patients who was treated at Hacettepe University Stem Cell Transplantation Unit. Amongst the 622 patients, 318 (51.1 %) underwent autologous and 304 (48.9 %) underwent allogeneic HSCT. The frequency of the cardiac adverse effects was found to be 10.8 % in all the study population. The most common adverse effect was tachyarrhythmia, constituting 7.9 % of all population. These adverse effects were mostly occurred in lymphoma patients (14 %). Nineteen (3.0 %) of all patients developed atrial fibrillation mostly on the 4th day (range of 1-9 days) after transplantation. Life-threatening events are extremely rare. These adverse effects appear to be related to the type of transplantation rather than the underlying disease. Therefore, close follow-up of patients is important during the peri-transplantation period.
Collapse
Affiliation(s)
- Elifcan Aladag
- Hacettepe University, Faculty of Medicine, Department of Hematology, 06100, Sihhiye, Ankara, Turkey
| | - Haluk Demiroglu
- Hacettepe University, Faculty of Medicine, Department of Hematology, 06100, Sihhiye, Ankara, Turkey
| | - Yahya Buyukasik
- Hacettepe University, Faculty of Medicine, Department of Hematology, 06100, Sihhiye, Ankara, Turkey
| | - Ugur N Karakulak
- Hacettepe University, Faculty of Medicine, Department of Hematology, 06100, Sihhiye, Ankara, Turkey
| | - Fatma Tekin
- Hacettepe University, Faculty of Medicine, Department of Hematology, 06100, Sihhiye, Ankara, Turkey
| | - Salih Aksu
- Hacettepe University, Faculty of Medicine, Department of Hematology, 06100, Sihhiye, Ankara, Turkey
| | - Hakan Goker
- Hacettepe University, Faculty of Medicine, Department of Hematology, 06100, Sihhiye, Ankara, Turkey.
| |
Collapse
|
22
|
Baker JK, Shank-Coviello J, Zhou B, Dixon J, McCorkle R, Sarpong D, Medoff E, Cooper D, Seropian S, Dai F. Cardiotoxicity in Hematopoietic Stem Cell Transplant: Keeping the Beat. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2020; 20:244-251.e4. [PMID: 32067953 DOI: 10.1016/j.clml.2019.12.027] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 12/21/2019] [Accepted: 12/28/2019] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The number of hematopoietic stem cell transplants (HSCTs) performed in the United States and worldwide is increasing. Cardiac events have been well described in HSCT, and the incidence and type of cardiac events have not changed over recent decades. PATIENTS AND METHODS This study adds to the body of evidence in describing the incidence and type of cardiac events experienced by an allogeneic and autologous HSCT population at a single institution from 2012 to 2017. RESULTS Sixty-five (9.8%) patients experienced cardiac events, including atrial arrhythmia (N = 39), acute heart failure (N = 9), acute coronary syndrome (N = 7), and new onset hypertension (N = 9), with a few instances of bradycardia, ventricular arrhythmia, pericardial effusion, and pericarditis. Our multivariable regression analysis identified age (older), creatinine (higher), and history of coronary artery disease to significantly correlate with risk of cardiac event (P = .005, P = .039, and P = .038, respectively). A subgroup analysis of those patients experiencing a cardiac event found pre-transplant atrial dilation by trans-thoracic echocardiogram to correlate with increased risk of atrial arrhythmia (33.8% vs. 9.7%; P = .03). Patients developing a CE had an increased risk of death within 1 year (11% vs. 32%; P < .001). CONCLUSION We review our results in context of other important HSCT cardiac studies to illuminate the most relevant factors of medical history, laboratory data, and cardiac measurements that will identify patients at higher risk, allowing for intervention to improve HSCT outcomes.
Collapse
Affiliation(s)
| | | | - Bin Zhou
- Department of Biostatistics, Yale University School of Public Health, New Haven, CT
| | - Jane Dixon
- School of Nursing, Yale University, Orange, CT
| | | | - Daniel Sarpong
- Center for Minority Health and Health Disparities Research and Education, Xavier University, New Orleans, LA
| | - Erin Medoff
- Department of Medicine, Yale University, New Haven, CT
| | - Dennis Cooper
- Department of Medicine, Stem Cell Transplantation, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Stuart Seropian
- Department of Medicine, Blood and Marrow Transplantation, Smilow Cancer Institute at Yale University, New Haven, CT
| | - Feng Dai
- Department of Biostatistics, Yale University School of Public Health, New Haven, CT
| |
Collapse
|
23
|
Alomar M, Fradley MG. Electrophysiology Translational Considerations in Cardio-Oncology: QT and Beyond. J Cardiovasc Transl Res 2019; 13:390-401. [DOI: 10.1007/s12265-019-09924-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 10/04/2019] [Indexed: 12/14/2022]
|
24
|
Chiengthong K, Lertjitbanjong P, Thongprayoon C, Bathini T, Sharma K, Prasitlumkum N, Mao MA, Cheungpasitporn W, Chokesuwattanaskul R. Arrhythmias in hematopoietic stem cell transplantation: A systematic review and meta-analysis. Eur J Haematol 2019; 103:564-572. [PMID: 31478231 DOI: 10.1111/ejh.13322] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Revised: 08/24/2019] [Accepted: 08/26/2019] [Indexed: 01/08/2023]
Abstract
BACKGROUND There are controversial data regarding the relationship between hematopoietic stem cell transplantation and arrhythmias. This meta-analysis was performed to evaluate the incidence of arrhythmias in patients following hematopoietic stem cell transplantation (HSCT). METHODS A literature search was conducted utilizing MEDLINE, EMBASE, and Cochrane Databases from inception through April 2019. Pooled incidence with 95% confidence interval (CI) were calculated using random-effects meta-analysis. The protocol for this meta-analysis is registered with PROSPERO (International Prospective Register of Systematic Reviews; no. CRD42019131833). RESULTS Thirteen studies consisting of 10,587 patients undergoing HSCT were enrolled in this systematic review. Overall, the pooled estimated incidence of all types of arrhythmias following HSCT was 7.2% (95% CI: 4.9%-10.5%). With respect to the most common type of arrhythmia, the pooled estimated incidence of atrial fibrillation/atrial flutter (AF/AFL) within 30 days following HSCT was 4.2% (95% CI: 1.7%-9.6%). Egger's regression test demonstrated no significant publication bias in this meta-analysis of post-HSCT arrhythmia incidence. CONCLUSION The overall estimated incidence of arrhythmias following HSCT was 7.2%. Future large scale studies are needed to further elucidate the significance and clinical impact of arrhythmias in post-HSCT patients.
Collapse
Affiliation(s)
- Kanhatai Chiengthong
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand.,King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | | | | | - Tarun Bathini
- Department of Internal Medicine, University of Arizona, Tucson, AZ, USA
| | - Konika Sharma
- Department of Internal Medicine, Bassett Medical Center, Cooperstown, NY, USA
| | - Narut Prasitlumkum
- University of Hawaii Internal Medicine Residency Program, Honolulu, HI, USA
| | - Michael A Mao
- Department of Internal Medicine, Mayo Clinic, Jacksonville, FL, USA
| | | | - Ronpichai Chokesuwattanaskul
- King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand.,Division of Cardiovascular Medicine, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| |
Collapse
|
25
|
Tuzovic M, Mead M, Young PA, Schiller G, Yang EH. Cardiac Complications in the Adult Bone Marrow Transplant Patient. Curr Oncol Rep 2019; 21:28. [PMID: 30826891 DOI: 10.1007/s11912-019-0774-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW Due to advancements in oncologic treatment strategies and techniques, the number of survivors who have undergone hematopoetic stem cell transplant (HCT) continues to increase in the United States; this number is projected to reach 502,000 by the year 2030. There is significant interest within the field of cardio-oncology to identify cardiotoxicity and cardiovascular disease in the HCT population. Epidemiologic studies analyzing both short- and long-term cardiovascular effects, risk stratification modeling, cardioprotective strategies, and expert consensus documents for cardiotoxicity surveillance recommendations are reviewed. RECENT FINDINGS Patients who have undergone HCT are at increased risk of cardiovascular events and mortality compared to matched controls. The type of cardiotoxicity and the incidence rates vary based on specific therapeutic regimens and pre-existing cardiovascular risk factors. Life-threatening cardiotoxicity can present during HCT as acute heart failure, arrhythmias, pericardial tamponade, or cardiac arrest; or it can present late after treatment as cardiomyopathy, ischemic heart disease, vascular disease, stroke, or comorbid conditions, such as hypertension and diabetes mellitus that are associated with cardiac events. HCT is associated with excess cardiovascular risk partially due to exposure to cardiotoxic chemotherapy and radiation, as well as indirect and direct detrimental effects on cardiovascular reserve. This review discusses the epidemiology and the known cardiotoxic effects of historical chemoradiation agents in addition to newer targeted therapies. Recent expert consensus statements from cardiology and hematology/oncology societies are reviewed in regard to risk stratification of the cancer patient based on the type of treatments. Finally, gaps in knowledge are identified with proposed avenues of research that will allow for more accurate risk assessment, prediction, and potential treatment of the HCT patient in attenuating the risk of developing both short- and long-term cardiovascular comorbidities.
Collapse
Affiliation(s)
- Mirela Tuzovic
- UCLA Cardio-Oncology Program, Division of Cardiology, Department of Medicine, University of California at Los Angeles, Los Angeles, CA, USA
| | - Monica Mead
- Division of Hematology and Oncology, Department of Medicine, University of California at Los Angeles, Los Angeles, CA, USA
| | - Patricia A Young
- Division of Hematology and Oncology, Department of Medicine, University of California at Los Angeles, Los Angeles, CA, USA
| | - Gary Schiller
- Division of Hematology and Oncology, Department of Medicine, University of California at Los Angeles, Los Angeles, CA, USA
| | - Eric H Yang
- UCLA Cardio-Oncology Program, Division of Cardiology, Department of Medicine, University of California at Los Angeles, Los Angeles, CA, USA.
| |
Collapse
|
26
|
Poręba M, Gać P, Usnarska-Zubkiewicz L, Pilecki W, Kuliczkowski K, Mazur G, Sobieszczańska M, Poręba R. The analysis of the parameters of 24-hr ECG Holter monitoring in patients with blood neoplasms undergoing high-dose chemotherapy and stem cell transplantation. Ann Noninvasive Electrocardiol 2018; 23:e12534. [PMID: 29363852 DOI: 10.1111/anec.12534] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Accepted: 12/08/2017] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Hematopoietic stem cell transplantation (HSCT) is a widely used procedure in the treatment of malignant diseases, including blood neoplasms and has increased survival in hematological diseases. The aim of the study was to analyze parameters of 24-hr ECG monitoring in patients with selected blood neoplasms in whom the procedure of hematopoietic stem cell transplantation was performed. METHODS The study group consisted of 64 adults diagnosed with hematologic cancer qualified for HSCT with the previous high dose chemotherapy (HDC). In all patients 24-hr Holter monitoring was carried out twice. First examination took place prior to the HSCT procedure, and the second after finishing the procedure of HSCT. RESULTS The minimal and mean heart rate (HR min and HR max) from 24-hr ECG recording was statistically significantly higher after the transplantation in comparison with the first test. The number of premature ventricular complexes (PVCs) was higher in the test after HSCT. In the second examination there was significantly higher percentage of premature ventricular complexes, incidents of tachycardia, and Mobitz type 1 second degree atrioventricular block. In regression analysis, in a group of patients with blood neoplasms after HSCT and HDC, administration of cyclophosphamide, fludarabine and total body irradiation were independent risk factors for electrocardiographic abnormalities in 24-hr Holter monitoring, that is, the increase in HR min, HR mean and PVCs. CONCLUSION In patients with blood neoplasms undergoing HSCT more electrocardiographic abnormalities may be found after this procedure in comparison with the 24-hr Holter monitoring before transplantation.
Collapse
Affiliation(s)
- Małgorzata Poręba
- Department of Pathophysiology, Wroclaw Medical University, Wroclaw, Poland
| | - Paweł Gać
- Department of Hygiene, Wroclaw Medical University, Wroclaw, Poland
| | - Lidia Usnarska-Zubkiewicz
- Department of Hematology, Blood Neoplasms and Bone Marrow Transplantation, Wroclaw Medical University, Wroclaw, Poland
| | - Witold Pilecki
- Department of Pathophysiology, Wroclaw Medical University, Wroclaw, Poland
| | - Kazimierz Kuliczkowski
- Department of Hematology, Blood Neoplasms and Bone Marrow Transplantation, Wroclaw Medical University, Wroclaw, Poland
| | - Grzegorz Mazur
- Department of Internal Medicine, Occupational Diseases and Hypertension, Wroclaw Medical University, Wroclaw, Poland
| | | | - Rafał Poręba
- Department of Internal Medicine, Occupational Diseases and Hypertension, Wroclaw Medical University, Wroclaw, Poland
| |
Collapse
|
27
|
Paraskevaidis IA, Makavos G, Tsirigotis P, Psarogiannakopoulos P, Parissis J, Gkirkas K, Pessach I, Ikonomidis I. Deformation Analysis of Myocardial Layers Detects Early Cardiac Dysfunction after Chemotherapy in Bone Marrow Transplantation Patients: A Continuous and Additive Cardiotoxicity Process. J Am Soc Echocardiogr 2017; 30:1091-1102. [DOI: 10.1016/j.echo.2017.07.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Indexed: 01/09/2023]
|
28
|
Assuncao BMBL, Handschumacher MD, Brunner AM, Yucel E, Bartko PE, Cheng KH, Campos O, Fathi AT, Tan TC, Scherrer-Crosbie M. Acute Leukemia is Associated with Cardiac Alterations before Chemotherapy. J Am Soc Echocardiogr 2017; 30:1111-1118. [PMID: 28927558 DOI: 10.1016/j.echo.2017.07.016] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Indexed: 10/18/2022]
Abstract
BACKGROUND Patients with acute leukemia (AL) have a higher rate of congestive heart failure than patients with other cancers. AL may predispose to cardiac dysfunction before chemotherapy because of high cytokine release or direct leukemic myocardial infiltration. The aims of this study were to evaluate whether AL is associated with abnormalities of myocardial structure and function before chemotherapy and to identify possible risk factors associated with these myocardial changes. METHODS Using an echocardiographic database, 76 patients with AL and 76 patients without cancer matched for age, gender, hypertension, and the presence of diabetes were retrospectively selected. Subsequently, to assess the effect of a nonhematologic malignancy, 28 women in each group were matched with women with breast cancer. Left ventricular (LV) mass, volumes, ejection fraction, and global longitudinal strain (GLS) were measured before chemotherapy. RESULTS The patients were predominantly male (63%), with a median age of 51 years, and had low prevalence of cardiovascular risk factors. Despite similar LV ejection fractions, patients with AL had higher LV mass and volumes and lower GLS (-19.3 ± 2.7% vs -20.9 ± 1.9%, P < .001) than patients without cancer. Similarly, GLS was lower in women with AL compared with women with breast cancer or without cancer. Among patients with AL, high body mass index, low LV ejection fraction, and a small number of circulating lymphocytes were all independently associated with low GLS. CONCLUSIONS Patients with AL had higher LV volumes and lower GLS than patients without cancer and lower GLS than patients with breast cancer, suggesting that AL by itself may be associated with these cardiac alterations.
Collapse
Affiliation(s)
- Bruna Morhy Borges Leal Assuncao
- Cardiac Ultrasound Laboratory, Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Division of Cardiology, Department of Internal Medicine, Federal University of Sao Paulo, Paulista School of Medicine, Sao Paulo, Brazil
| | - Mark D Handschumacher
- Cardiac Ultrasound Laboratory, Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Andrew M Brunner
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Evin Yucel
- Cardiac Ultrasound Laboratory, Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Philipp E Bartko
- Cardiac Ultrasound Laboratory, Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Kai-Hung Cheng
- Cardiac Ultrasound Laboratory, Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Orlando Campos
- Division of Cardiology, Department of Internal Medicine, Federal University of Sao Paulo, Paulista School of Medicine, Sao Paulo, Brazil
| | - Amir T Fathi
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Timothy C Tan
- Blacktown Clinical School, Department of Cardiology, Faculty of Medicine, University of Western Sydney, and School of Medical Sciences, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Marielle Scherrer-Crosbie
- Cardiac Ultrasound Laboratory, Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Cardiac Ultrasound Laboratory, University of Pennsylvania, Philadelphia, Pennsylvania.
| |
Collapse
|
29
|
The incidence of atrial fibrillation among patients with AL amyloidosis undergoing high-dose melphalan and stem cell transplantation: experience at a single institution. Bone Marrow Transplant 2017; 52:1349-1351. [DOI: 10.1038/bmt.2017.148] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
30
|
Viganego F, Singh R, Fradley MG. Arrhythmias and Other Electrophysiology Issues in Cancer Patients Receiving Chemotherapy or Radiation. Curr Cardiol Rep 2016; 18:52. [DOI: 10.1007/s11886-016-0730-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
|
31
|
Blaes A, Konety S, Hurley P. Cardiovascular Complications of Hematopoietic Stem Cell Transplantation. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2016; 18:25. [PMID: 26909819 PMCID: PMC4766226 DOI: 10.1007/s11936-016-0447-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OPINION STATEMENT Survivors of hematopoietic stem cell transplant (HSCT) are at significant risk for cardiac disease and cardiac complications. While there may be cardiac complications during the acute period of HSCT, long-term survivors remain at risk for cardiovascular disease at a rate at least fourfold higher than the general population. Aggressive screening for cardiac risk factors such as diabetes, hypertension, and arrhythmias is warranted pretransplant. For those with risk factors, particularly a history of cardiovascular disease or atrial fibrillation, cardiology consultation is warranted in the pretransplantation period. Aggressive screening for cardiac risk factors such as diabetes, hypertension, and hyperlipidemia is warranted in HSCT survivors as well; early and aggressive treatment of left ventricular dysfunction is warranted. Collaboration between hematology/oncology and cardiology through a cardio-oncology clinic is an optimal way to help manage these patients.
Collapse
Affiliation(s)
- Anne Blaes
- Division of Hematology/Oncology/Transplantion, University of Minnesota, 420 Delaware Street, S.E., MMC 480, Minneapolis, MN, 55455, USA.
| | - Suma Konety
- Division of Cardiology, University of Minnesota, Minneapolis, MN, USA
| | - Peter Hurley
- Division of Hematology/Oncology/Transplantion, University of Minnesota, 420 Delaware Street, S.E., MMC 480, Minneapolis, MN, 55455, USA
| |
Collapse
|
32
|
Mathur P, Paydak H, Thanendrarajan S, van Rhee F. Atrial Fibrillation in Hematologic Malignancies, Especially After Autologous Hematopoietic Stem Cell Transplantation: Review of Risk Factors, Current Management, and Future Directions. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2016; 16:70-5. [DOI: 10.1016/j.clml.2015.10.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2015] [Revised: 10/13/2015] [Accepted: 10/16/2015] [Indexed: 12/19/2022]
|
33
|
Scott JM, Armenian S, Giralt S, Moslehi J, Wang T, Jones LW. Cardiovascular disease following hematopoietic stem cell transplantation: Pathogenesis, detection, and the cardioprotective role of aerobic training. Crit Rev Oncol Hematol 2016; 98:222-34. [PMID: 26643524 PMCID: PMC5003053 DOI: 10.1016/j.critrevonc.2015.11.007] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Revised: 11/10/2015] [Accepted: 11/11/2015] [Indexed: 01/02/2023] Open
Abstract
Advances in hematopoietic cell transplantation (HCT) techniques and supportive care strategies have led to dramatic improvements in relapse mortality in patients with high-risk hematological malignancies. These improvements, however, conversely increase the risk of late-occurring non-cancer competing causes, mostly cardiovascular disease (CVD). HCT recipients have a significantly increased risk of CVD-specific mortality, including elevated incidence of coronary artery disease (CAD), cerebrovascular disease, and heart failure (HF) compared to age-matched counterparts. Accordingly, there is an urgent need to identify techniques for the detection of early CVD in HCT patients to inform early prevention strategies. Aerobic training (AT) is established as the cornerstone of primary and secondary disease prevention in multiple clinical settings, and may confer similar benefits in HCT patients at high-risk of CVD. The potential benefits of AT either before, immediately after, or in the months/years following HCT have received limited attention. Here, we discuss the risk and extent of CVD in adult HCT patients, highlight novel tools for early detection of CVD, and review existing evidence in oncology and non-oncology populations supporting the efficacy of AT to attenuate HCT-induced CVD. This knowledge can be utilized to optimize treatment, while minimizing CVD risk in individuals with hematological malignancies undergoing HCT.
Collapse
Affiliation(s)
- Jessica M Scott
- Universities Space Research Association NASA Johnson Space Center, Houston, TX, USA
| | - Saro Armenian
- City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Sergio Giralt
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | | | - Lee W Jones
- Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| |
Collapse
|
34
|
Tonorezos ES, Stillwell EE, Calloway JJ, Glew T, Wessler JD, Rebolledo BJ, Pham A, Steingart RM, Lazarus H, Gale RP, Jakubowski AA, Schaffer WL. Arrhythmias in the setting of hematopoietic cell transplants. Bone Marrow Transplant 2015; 50:1212-6. [PMID: 26030046 PMCID: PMC4558298 DOI: 10.1038/bmt.2015.127] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Revised: 03/15/2015] [Accepted: 04/09/2015] [Indexed: 11/15/2022]
Abstract
Prior studies report 9–27% of persons receiving a hematopoietic cell transplant develop arrhythmias, but the effect on outcomes is largely unknown. We reviewed data from 1177 consecutive patients {greater than or equal to}40 years old receiving a hematopoietic cell transplant at one center during 1999–2009. Transplant indication was predominately leukemia, lymphoma and multiple myeloma. Overall, 104 patients were found to have clinically significant arrhythmia: 43 prior to and 61 following transplant. Post-transplant arrhythmias were most frequently atrial fibrillation(N=30), atrial flutter(N=7) and supraventricular tachycardia(N=11). Subjects with an arrhythmia post-transplant were more likely to have longer median hospital stays (32 days vs 23, P=<.001,) a greater probability of an ICU admission (52% vs 7%; P<.001), more inhospital deaths (28% vs 3%, P<0.001), and more deaths within one year of transplant (41% vs 15%; P<0.001) than patients without arrhythmia at any time. In a multivariate model including age at transplant, diagnosis, history of pre-transplant arrhythmia, and transplant-related variables, post-transplant arrhythmia was associated with a greater risk of death within a year of transplant (OR 3.5, 95% CI: 2.1, 5.9; P < 0.001). Our data suggest arrhythmias after transplants are associated with significant morbidity and mortality. A prospective study of arrhythmia in the transplant setting is warranted.
Collapse
Affiliation(s)
- E S Tonorezos
- Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.,Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - E E Stillwell
- Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - J J Calloway
- Department of Medicine, Hospital for Special Surgery, New York, NY, USA
| | - T Glew
- Department of Medicine, Beth Israel Medical Center, New York, NY, USA
| | - J D Wessler
- Department of Medicine, New York Presbyterian-Columbia, New York, NY, USA
| | - B J Rebolledo
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - A Pham
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - R M Steingart
- Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.,Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - H Lazarus
- Department of Medicine, UH Case Medical Center, Cleveland, OH, USA
| | - R P Gale
- Haematology Research Centre, Division of Experimental Medicine, Department of Medicine, Imperial College London, London, UK
| | - A A Jakubowski
- Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.,Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - W L Schaffer
- Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.,Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| |
Collapse
|
35
|
Hurley P, Konety S, Cao Q, Weisdorf D, Blaes A. Hematopoietic stem cell transplantation in patients with systolic dysfunction: can it be done? Biol Blood Marrow Transplant 2014; 21:300-4. [PMID: 25464117 DOI: 10.1016/j.bbmt.2014.10.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Accepted: 10/13/2014] [Indexed: 01/06/2023]
Abstract
Hematopoietic cell transplantation (HCT) is a potential cure for certain hematologic malignancies. However, because of risks of complications and mortality, this treatment option is limited to patients with minimal comorbidities. We performed a retrospective cohort study evaluating the impact of pre-HCT systolic dysfunction on outcomes. We identified 49 subjects with systolic dysfunction, defined as left ventricular ejection fraction (LVEF) < 50% and 49 controls (matched by age, gender, conditioning regimen, and HCT donor number; all with LVEF ≥ 50%) undergoing HCT at the University of Minnesota between 2002 and 2012. Treatment complications, use of beta-blockers and angiotensin-converting enzyme inhibitors, and overall survival (OS) after HCT out to 24 months were analyzed. The median LVEF was 45% (range, 27.5% to 49%) for the study group and 60% (range, 50% to 69%) for controls. The majority of patients in both groups (81.6%) received reduced-intensity conditioning (RIC). Treatment-related mortality (TRM) at day 100 was identical, with a cumulative incidence of 14% in the study (95% confidence interval [CI], 5% to 24%) versus 14% in controls (95% CI, 5% to 24%) (P = .89). Two-year OS was similar in the study group (53%; 95% CI, 38% to 66%) versus controls (61%; 95% CI, 46% to 73%) (P = .34). LVEF ≥ 43% was associated with improved OS at 1 year (hazard ratio [HR], .36; 95% CI, .15 to .87; P = .02). There was no significant difference in the incidence of non-life-threatening cardiac complications (12.2% in cases versus 8.2% in controls, P = .50) or serious (life-threatening or fatal) cardiac complications (4.1% in cases versus 2.0% in controls, P = .56). Pre-existing coronary artery disease was associated with increased TRM at 100 days (HR, 4.35; 95% CI, 1.24 to 15.32; P = .02). Cardiac medication use had no effect on TRM. Our study demonstrates that patients with asymptomatic borderline systolic dysfunction can safely undergo HCT with RIC. Coronary artery disease remains a risk factor for increased TRM. Patients with borderline systolic dysfunction can safely undergo HCT, but may need particular vigilance for potential hemodynamic or ischemic cardiac complications.
Collapse
Affiliation(s)
- Peter Hurley
- Division of Hematology Oncology and Transplantation, Department of Medicine, University of Minnesota, Minneapolis, Minnesota.
| | - Suma Konety
- Division of Cardiovascular Diseases, University of Minnesota, Minneapolis, Minnesota
| | - Qing Cao
- Biostatistic Core, Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota
| | - Daniel Weisdorf
- Division of Hematology Oncology and Transplantation, Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Anne Blaes
- Division of Hematology Oncology and Transplantation, Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| |
Collapse
|
36
|
Ozkan HA, Bal C, Gulbas Z. Assessment and comparison of acute cardiac toxicity during high-dose cyclophosphamide and high-dose etoposide stem cell mobilization regimens with N-terminal pro-B-type natriuretic peptide. Transfus Apher Sci 2013; 50:46-52. [PMID: 24382557 DOI: 10.1016/j.transci.2013.12.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Revised: 11/19/2013] [Accepted: 12/02/2013] [Indexed: 01/25/2023]
Abstract
This study was undertaken to prospectively evaluate and compare the acute effect of high-dose (HD), cyclophosphamide (CY) and HD etoposide (ET) on cardiac function assessed by plasma N-terminal pro-B-type natriuretic peptide (NT-proBNP) in patients undergoing stem-cell mobilization. NT-proBNP was measured at baseline and 6h after completion of mobilization chemotherapy (MC) in 58 patients. Of 58 patients, 33 received HD CY, and 25 received HD ET. The mean baseline NT-proBNP values were similar between the CY and ET group (119.5 vs 149, respectively, p>0.05). NT-proBNP levels were increased in almost all patients, except 2 from CY group. A significant difference between NT-proBNP concentrations at baseline and 6h after completion of MC was observed in both groups (p<0.001). The value of changes in NT-proBNP was more significant in the ET group. The changes in NT-proBNP according to the MC regimens were analyzed and a cut-off value of 422pg/ml was determined. Based on this cut-off value, only the type of MC was significantly correlated with the chances in NT-proBNP concentrations. Receiving HD ET as a MC was found to be 5.25 times more cardiotoxic compared to the HD CY. Congestive heart failure was seen in 3 (5.2%) patients. Our results suggest that stem cell mobilization with HD CY and HD ET cause acute cardiac toxicity mediated by neurohumoral activation, which was detected by the increases in cardiac biomarker NT-proBNP, and as a matter of fact cardiotoxicity of HD ET seems to be more potent than those exhibited by HD CY.
Collapse
Affiliation(s)
- Hasan Atilla Ozkan
- Anadolu Medical Center Hospital, Bone Marrow Transplantation Center, Cumhuriyet Mah. 2255 sk. No. 3, Gebze 41400, Kocaeli, Turkey
| | - Cengiz Bal
- Biostatistic Department, Eskişehir Osmangazi University School of Medicine, Meşelik, 26480 Eskişehir, Turkey
| | - Zafer Gulbas
- Anadolu Medical Center Hospital, Bone Marrow Transplantation Center, Cumhuriyet Mah. 2255 sk. No. 3, Gebze 41400, Kocaeli, Turkey.
| |
Collapse
|
37
|
Incidence of supraventricular arrhythmias during autologous peripheral blood stem cell transplantation. Biol Blood Marrow Transplant 2013; 19:1233-7. [PMID: 23747600 DOI: 10.1016/j.bbmt.2013.05.019] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2012] [Accepted: 05/29/2013] [Indexed: 11/19/2022]
Abstract
Arrhythmias, especially supraventricular arrhythmias, often complicate the clinical course during autologous hematopoietic cell transplantation (AHCT). We wanted to determine the incidence and risk factors for cardiac arrhythmias during AHCT. The study included 983 patients (median age, 58 years [range, 19 to 77]; 61% male) who underwent AHCT between August 2006 and December 2010 at a single institution and for whom all relevant medical records were available for review. AHCT was done for plasma cell disorders in 58% patients and for lymphoma or leukemia in the remaining. Overall, 92 patients (9.4%) developed a supraventricular tachyarrhythmia at a median of 9 days posttransplantation (range, 0 to 18) and with a median duration of less than 1 day (range, <1 to 17 days). Atrial fibrillation was the most common and seen in 71 patients (7%), followed by atrial flutter and supraventricular tachycardia in 12 (1%) and 8 (1%) patients, respectively. In multivariate analysis, age older than 63 years, presence of premature supraventricular complexes or atrioventricular conduction delay on pretransplantation electrocardiogram, and history of any prior arrhythmia increased the risk of arrhythmia. Development of arrhythmia resulted in longer outpatient follow-up after AHCT, with the median follow-up for those developing an arrhythmia of 22 days compared with 19 days for the rest; P < .001. In conclusion, 9% of patients undergoing ASCT developed supraventricular arrhythmias posttransplantation, and this risk was elevated among older patients, those with a prior history of arrhythmias, and those with pretransplantation electrocardiographic abnormalities.
Collapse
|
38
|
Factors affecting the development of atrial fibrillation and atrial flutter (AF/AFL) following autologous hematopoietic SCT (auto-HSCT). Bone Marrow Transplant 2012; 48:963-5. [PMID: 23222385 DOI: 10.1038/bmt.2012.253] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2012] [Revised: 10/29/2012] [Accepted: 11/06/2012] [Indexed: 11/08/2022]
Abstract
The use of autologous hematopoietic SCT (auto-HSCT) has expanded to include older patients. Increasing age is a well-appreciated risk factor for the development of atrial fibrillation and/or atrial flutter (AF/AFL) in the general population. As more elderly patients undergo auto-HSCT, the risk of developing AF/AFL post transplant may also increase. However, few data evaluating other risk factors for the development of AF/AFL following auto-HSCT exist. Therefore, we performed a retrospective study to determine the incidence of AF/AFL following auto-HSCT and to determine the risk factors associated with the development of AF/AFL. Patients who developed AF/AFL were compared with a group of patients who received auto-HSCT within the same time period (April 1999 to May 2005) and were within 5 years of age. Of the 516 patients who underwent auto-HSCT at the University of Nebraska Medical Center 44 (8.5%) developed AF/AFL at a median time of 4 days (range, days 1-9) following auto-HSCT. In multivariate analysis, risk factors for developing AF/AFL were older age, odds ratio and 95% CI of 1.14 (1.07-1.21), elevated serum creatinine level, 2.69 (1.00-7.22), history of previous arrhythmia, 9.33 (3.01-28.99), and history of previous mediastinal irradiation, 11.12 (1.33-92.96).
Collapse
|
39
|
Barba P, Martino R, Perez-Simón JA, Fernández-Avilés F, Piñana JL, Valcárcel D, Campos-Varela I, Lopez-Anglada L, Rovira M, Novelli S, Lopez-Corral L, Carreras E, Sierra J. Incidence, characteristics and risk factors of marked hyperbilirubinemia after allogeneic hematopoietic cell transplantation with reduced-intensity conditioning. Bone Marrow Transplant 2012; 47:1343-9. [PMID: 22388280 DOI: 10.1038/bmt.2012.25] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
To analyze the incidence, characteristics and risk factors of hyperbilirubinemia after allogeneic hematopoietic cell transplantation with reduced-intensity conditioning (allo-RIC), we conducted a retrospective study in three Spanish centers. We analyzed 452 consecutive patients receiving allo-RIC. Of these, 92 patients (20%) developed marked hyperbilirubinemia (>4 mg/day or >68.4 μM) after allo-RIC. The main causes of marked hyperbilirubinemia after transplant were cholestasis due to GVHD or sepsis (n=57, 62%) and drug-induced cholestasis (n=13, 14%). A total of 22 patients with marked hyperbilirubinemia (24%) underwent liver biopsy. The most frequent histological finding was iron overload alone (n=6) or in combination with other features (n=6). In multivariate analysis, the risk factors for marked hyperbilirubinemia after allo-RIC were non-HLA-identical sibling donors (hazard ratio (HR) 2.2 (95% confidence interval (CI) 1.4-3.6) P=0.001), female donors to male recipients (HR 2.1 (95% CI 1.3-3.3) P=0.003) and high levels of bilirubin and γ-glutamyl transpeptidase before transplant (HR 4.5 (95% CI 2.5-8.4) P<0.001 and HR 4.6 (95% CI 2.6-8.1) P<0.001, respectively). Patients with marked hyperbilirubinemia showed higher 4-year nonrelapse mortality (HR 1.3 (95% CI 1-1.7), P=0.02) and lower 4-year OS (HR 1.4 (95%CI 1.3-1.7), P<0.001) than patients without. In conclusion, we confirm that marked hyperbilirubinemia is frequent and diverse after allo-RIC. Development of marked hyperbilirubinemia after allo-RIC is associated with worse outcome of the procedure.
Collapse
Affiliation(s)
- P Barba
- Department of Hematology, Hospital de la Santa Creu i Sant Pau de Barcelona, Barcelona, Spain.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
40
|
Roziakova L, Bojtarova E, Mistrik M, Dubrava J, Gergel J, Lenkova N, Mladosievicova B. Serial measurements of cardiac biomarkers in patients after allogeneic hematopoietic stem cell transplantation. JOURNAL OF EXPERIMENTAL & CLINICAL CANCER RESEARCH : CR 2012; 31:13. [PMID: 22321767 PMCID: PMC3293081 DOI: 10.1186/1756-9966-31-13] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2011] [Accepted: 02/09/2012] [Indexed: 12/19/2022]
Abstract
Background Previous therapy with anthracyclines (ANT) and conditioning regimen followed by hematopoietic stem cell transplantation (HSCT) represents a high risk for development of cardiotoxicity. The aim of this study was to assess subclinical myocardial damage after HSCT using echocardiography and cardiac biomarkers - high sensitive cardiac troponin T (hs-cTnT) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) and to identify patients at risk of developing clinical cardiotoxicity. Patients and methods Thirty-seven patients who were treated with allogeneic HSCT for hematologic diseases at median age of 28 years at time of HSCT were studied. Conditioning regimen included either chemotherapy without total body irradiation (TBI) or combination of chemotherapy with TBI. Twenty-nine (78,3%) patients were pretreated with ANT therapy. Cardiac biomarkers were serially measured before conditioning regimen and at days 1, 14 and 30 after HSCT. Cardiac systolic and diastolic functions were assessed before conditioning regimen and 1 month after HSCT by echocardiography. Results The changes in plasma NT-proBNP and hs-cTnT levels during the 30 days following the HSCT were statistically significant (P < 0,01 v.s. P < 0,01). Persistent elevations of NT-proBNP and hs-cTnT simultaneously for a period exceeding 14 days after HSCT were found in 29,7% patients. Serum concentrations of cardiomarkers were significantly elevated in ANT group compared to non-ANT group. These observations were underscored by the echocardiographic studies which did reveal significant changes in systolic and diastolic parameters. Five of 37 (13,5%) patients developed clinical manifestation of cardiotoxicity. Conclusions Elevations in both cardiac biomarkers were found before clinical signs of cardiotoxicity developed. Persistent elevations in NT-pro-BNP and hs-cTnT concentrations simultaneously for a period exceeding 14 days might be used for identification of patients at risk of developing cardiotoxicity and requiring further cardiological follow up.
Collapse
Affiliation(s)
- Lubica Roziakova
- Institute of Pathological Physiology, School of Medicine, Comenius University, Bratislava, Slovakia
| | | | | | | | | | | | | |
Collapse
|
41
|
Changes in echocardiographic measures of systolic and diastolic function in children 1 year after hematopoietic SCT. Bone Marrow Transplant 2011; 46:1532-9. [PMID: 21278798 DOI: 10.1038/bmt.2010.345] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Hematopoietic SCT (HSCT) is a life-saving therapy in children, but has been associated with heart failure. Little is known about subclinical changes in cardiac function. We examined changes in systolic and diastolic function from pre- to 1-year post HSCT by echocardiography. All patients (n=74, 61% men, median age 9.1 years, mean left-ventricular (LV) ejection fraction 61.3±4.9%) who underwent HSCT at Children's Hospital Boston between 2005 and 2008, were <21 years at time of HSCT, and had routine pre- and 1-year post echocardiograms were included. Systolic function parameters, including LV ejection fraction, rate-corrected velocity of fiber shortening (Vcfc) and stress-velocity index and diastolic parameters, including tissue Doppler imaging (TDI)-derived velocities, and left-ventricular flow propagation, were compared before and after transplant. At 1-year post HSCT, systolic function, as measured by Vcfc (1.10±0.15 vs 1.04±0.12 circ/s; P=0.03) and stress-velocity index (z-score 0.40±1.4 vs -0.20±1.1; P=0.02), had worsened; diastolic function parameters, including mitral E' velocity (16.6±3.9 vs 15.0±3.4 cm/s; P=0.01) and tricuspid E' velocity (14.3±3.6 vs 12.4±2.8 cm/s; P=0.002) had also decreased. At 1-year post HSCT, children have subclinical declines in systolic and diastolic function. These small changes might become clinically important over time. Serial non-invasive assessment of cardiac function should be considered in all children following HSCT.
Collapse
|
42
|
Marvi M, Rose JB, Bang A, Moon BC, Pozeg Z, Ibrahim M, Peniston C, Coe IR. Nucleoside transporter expression profiles in human cardiac tissue show striking individual variability with overall predominance of hENT1. Eur J Pharm Sci 2010; 41:685-91. [PMID: 20883780 DOI: 10.1016/j.ejps.2010.09.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2010] [Revised: 09/17/2010] [Accepted: 09/21/2010] [Indexed: 11/25/2022]
Abstract
Nucleoside transporters (NTs) are integral membrane transport proteins that modulate the flux of nucleosides such as adenosine across cell membranes. Two families of NTs exist, the concentrative NTs (CNTs, SLC28) and the equilibrative NTs (ENTs, SLC29). CNTs and ENTs transport anti-cancer and anti-viral nucleoside analog drugs and ENTs are also targets of drugs used to treat cardiac pathologies. Levels of some NT profiles have been shown to relate to clinical outcomes in the use of nucleoside analog drugs. However, currently, patient NT profile is not assessed prior to pharmacological administration of analog drugs. Here we describe a reliable method to determine a complete individual NT expression profile from human tissue using quantitative real-time PCR. We developed this assay on tissue (right atrial appendage, left internal mammary, aorta) from individuals undergoing cardiac surgery and compared these findings to the NT expression profiles in pooled whole heart tissue (normal and diseased). Data show that hENT1 is the most abundantly expressed NT, with highest expression levels in the aorta. However, NT expression profiles are highly variable among individuals and changes in NT expression between normal and diseased tissues were observed. These data are the first to describe the RNA expression patterns of all seven NT isoforms in the human heart. The methodology described here may be useful for quantitatively characterizing complete NT expression profiles in any human target tissue.
Collapse
Affiliation(s)
- Melissa Marvi
- Department of Biology, Muscle Health Research Centre, York University, Toronto, ON, Canada
| | | | | | | | | | | | | | | |
Collapse
|