.: ORİJİNAL ARAŞTIRMA
Early Cardiac Complications in the First Month After Hematopoietic Stem Cell Transplantation: A Retrospective Analysis
Hematopoietik Kök Hücre Naklinden Sonraki İlk Ayda Gelişen Erken Kardiyak Komplikasyonlar: Retrospektif Bir Analiz
Turkiye Klinikleri J Med Sci. 2021;41(4):416-23
doi: 10.5336/medsci.2021-84365
Makale Dili: EN
Tam Metin
ABSTRACT
Objective: Cardiological evaluation before transplantation is extremely important in predicting cardiac complications in hematopoietic stem cell transplantation (HSCT) patients. In this study, our aim is to determine the incidence of post-HSCT early cardiac complications' mortality and morbidity and to identify the risk factors which act on the development of cardiac complications. Material and Methods: This study included 218 patients who had undergone HSCT during the time period between January 2014 and January 2020. Patient data were retrospectively retrieved from patient charts and internal electronic record database. Results: Fifty six % (n=122) were males and median age of the cohort was 55 (47-63) years. Eight (3.6%) patients developed Grade III-IV cardiac complications. Patients with ST-T alterations in the pre-transplant electrocardiogram (ECG) had a higher rate of cardiac complications (chi-square, p=0.019). Among the conditioning regimens, cardiac toxicity was determined at a higher rate the group who received melphalan 200 mg/m2 (p=0.040). Conclusion: ST segment and T-wave alterations observed in ECG, pulmonary arterial pressure as measured by electrocardiography and particularly a reading over ˃25 mmHg, utilization of melpahalan 200 mg/m2 as conditioning regimen feature out as the most important risk factors for cardiac complications which may develop subsequent to HSCT.
Keywords: Hematopoietic stem cell transplantation; cardiac toxicity; risk factors
Objective: Cardiological evaluation before transplantation is extremely important in predicting cardiac complications in hematopoietic stem cell transplantation (HSCT) patients. In this study, our aim is to determine the incidence of post-HSCT early cardiac complications' mortality and morbidity and to identify the risk factors which act on the development of cardiac complications. Material and Methods: This study included 218 patients who had undergone HSCT during the time period between January 2014 and January 2020. Patient data were retrospectively retrieved from patient charts and internal electronic record database. Results: Fifty six % (n=122) were males and median age of the cohort was 55 (47-63) years. Eight (3.6%) patients developed Grade III-IV cardiac complications. Patients with ST-T alterations in the pre-transplant electrocardiogram (ECG) had a higher rate of cardiac complications (chi-square, p=0.019). Among the conditioning regimens, cardiac toxicity was determined at a higher rate the group who received melphalan 200 mg/m2 (p=0.040). Conclusion: ST segment and T-wave alterations observed in ECG, pulmonary arterial pressure as measured by electrocardiography and particularly a reading over ˃25 mmHg, utilization of melpahalan 200 mg/m2 as conditioning regimen feature out as the most important risk factors for cardiac complications which may develop subsequent to HSCT.
Keywords: Hematopoietic stem cell transplantation; cardiac toxicity; risk factors
ÖZET
Amaç: Kardiyak toksisite, hematopoietik kök hücre nakli (HKHN) için en önemli sınırlayıcı faktörlerden biridir. HKHN hastalarında, pretransplant kardiyolojik değerlendirmenin kardiyak komplikasyonları öngörmedeki yararlılığı hâlen tartışmalıdır. Bu çalışmada amacımız, HKHN sonrası gelişen yaşamı tehdit edici ve fatal kardiyak komplikasyon insidansını saptamak ve kardiyak komplikasyon gelişimine etkili olan faktörleri belirlemektir. Gereç ve Yöntemler: Ocak 2014-Ocak 2020 yılları arasında HKHN yapılan 218 hasta çalışmaya dâhil edildi. Hasta sonuçlarına hasta dosyalarından ve elektronik kayıt sisteminden, retrospektif olarak ulaşıldı. Bulgular: Hastaların %56'sı (n=122) erkek, ortanca yaşları 55 (47-63) yıl idi. Sekiz (%3,6) hastada Grade III-IV kardiyak komplikasyon gelişti. HKHN öncesi değerlendirilen elektrokardiyogramda (EKG) ST-T değişiklikleri olan hastalarda, kardiyak komplikasyon gelişimi daha sık idi (ki-kare, p=0,019). Hazırlama rejimleri içerisinde melphalan 200 mg/m2 kullananlarda kardiyak toksisite daha sık saptandı (p=0,040). Sonuç: EKG'deki ST segment ve T dalga değişiklikleri, elektrokardiyografide değerlendirilen pulmoner arteriyel basınç (PAB), özellikle de PAB değeri ˃25 mmHg olması ve hazırlık rejimi olarak melfalan 200 mg/m2 kullanımı HKHN sonrası gelişebilecek kardiyak komplikasyonlar açısından en önemli risk faktörleridir.
Anahtar Kelimeler: Hematopoietik kök hücre naklî; kardiyak toksisite; risk faktörleri
Amaç: Kardiyak toksisite, hematopoietik kök hücre nakli (HKHN) için en önemli sınırlayıcı faktörlerden biridir. HKHN hastalarında, pretransplant kardiyolojik değerlendirmenin kardiyak komplikasyonları öngörmedeki yararlılığı hâlen tartışmalıdır. Bu çalışmada amacımız, HKHN sonrası gelişen yaşamı tehdit edici ve fatal kardiyak komplikasyon insidansını saptamak ve kardiyak komplikasyon gelişimine etkili olan faktörleri belirlemektir. Gereç ve Yöntemler: Ocak 2014-Ocak 2020 yılları arasında HKHN yapılan 218 hasta çalışmaya dâhil edildi. Hasta sonuçlarına hasta dosyalarından ve elektronik kayıt sisteminden, retrospektif olarak ulaşıldı. Bulgular: Hastaların %56'sı (n=122) erkek, ortanca yaşları 55 (47-63) yıl idi. Sekiz (%3,6) hastada Grade III-IV kardiyak komplikasyon gelişti. HKHN öncesi değerlendirilen elektrokardiyogramda (EKG) ST-T değişiklikleri olan hastalarda, kardiyak komplikasyon gelişimi daha sık idi (ki-kare, p=0,019). Hazırlama rejimleri içerisinde melphalan 200 mg/m2 kullananlarda kardiyak toksisite daha sık saptandı (p=0,040). Sonuç: EKG'deki ST segment ve T dalga değişiklikleri, elektrokardiyografide değerlendirilen pulmoner arteriyel basınç (PAB), özellikle de PAB değeri ˃25 mmHg olması ve hazırlık rejimi olarak melfalan 200 mg/m2 kullanımı HKHN sonrası gelişebilecek kardiyak komplikasyonlar açısından en önemli risk faktörleridir.
Anahtar Kelimeler: Hematopoietik kök hücre naklî; kardiyak toksisite; risk faktörleri
REFERANSLAR:
- Sorror ML, Maris MB, Storb R, Baron F, Sandmaier BM, Maloney DG, et al. Hematopoietic cell transplantation (HCT)-specific comorbidity index: a new tool for risk assessment before allogeneic HCT. Blood. 2005;106(8): 2912-9. [Crossref] [PubMed] [PMC]
- Bearman SI, Petersen FB, Schor RA, Denney JD, Fisher LD, Appelbaum FR, et al. Radionuclide ejection fractions in the evaluation of patients being considered for bone marrow transplantation: risk for cardiac toxicity. Bone Marrow Transplant. 1990;5(3):173-7. [PubMed]
- Hertenstein B, Stefanic M, Schmeiser T, Scholz M, Göller V, Clausen M, et al. Cardiac toxicity of bone marrow transplantation: predictive value of cardiologic evaluation before transplant. J Clin Oncol. 1994;12(5):998-1004. [Crossref] [PubMed]
- Cazin B, Gorin NC, Laporte JP, Gallet B, Douay L, Lopez M, et al. Cardiac complications after bone marrow transplantation. A report on a series of 63 consecutive transplan tations. Cancer. 1986;57(10):2061-9. [Crossref] [PubMed]
- Styler MJ, Topolsky DL, Crilley PA, Covalesky V, Bryan R, Bulova S, et al. Transient high grade heart block following autologous bone marrow infusion. Bone Marrow Transplant. 1992;10(5):435-8. [PubMed]
- Murdych T, Weisdorf DJ. Serious cardiac complications during bone marrow transplantation at the University of Minnesota, 1977-1997. Bone Marrow Transplant. 2001;28(3):283-7. [Crossref] [PubMed]
- Sakata-Yanagimoto M, Kanda Y, Nakagawa M, Asano-Mori Y, Kandabashi K, Izutsu K, et al. Predictors for severe cardiac complications after hematopoietic stem cell transplantation. Bone Marrow Transplant. 2004;33(10):1043-7. [Crossref] [PubMed]
- Fujimaki K, Maruta A, Yoshida M, Sakai R, Tanabe J, Koharazawa H, et al. Severe cardiac toxicity in hematological stem cell transplantation: predictive value of reduced left ventricular ejection fraction. Bone Marrow Transplant. 2001; 27(3):307-10. [Crossref] [PubMed]
- Kupari M, Volin L, Suokas A, Hekali P, Ruutu T. Cardiac involvement in bone marrow transplantation: serial changes in left ventricular size, mass and performance. J Intern Med. 1990;227(4):259-66. [Crossref] [PubMed]
- Crossley RJ. Clinical safety and tolerance of mitoxantrone. Semin Oncol. 1984;11(3 Suppl 1):54-8. [PubMed]
- Von Hoff DD, Rozencweig M, Layard M, Slavik M, Muggia FM. Daunomycin-induced cardiotoxicity in children and adults. A review of 110 cases. Am J Med. 1977;62(2):200-8. [Crossref] [PubMed]
- Blaes A, Konety S, Hurley P. Cardiovascular complications of hematopoietic stem cell transplantation. Curr Treat Options Cardiovasc Med. 2016;18(4):25. [Crossref] [PubMed] [PMC]
- Singla A, Hogan WJ, Ansell SM, Buadi FK, Dingli D, Dispenzieri A, et al. Incidence of supraventricular arrhythmias during autologous peripheral blood stem cell transplantation. Biol Blood Marrow Transplant. 2013; 19(8):1233-7. [Crossref] [PubMed] [PMC]
- Poręba M, Gać P, Usnarska-Zubkiewicz L, Pilecki W, Kuliczkowski K, Mazur G, et al. Echocardiographic evaluation of the early cardiotoxic effect of hematopoietic stem cell transplantation in patients with hematologic malignancies. Leuk Lymphoma. 2016;57(9): 2119-25. [Crossref] [PubMed]
- Armenian SH, Ryan TD, Khouri MG. Cardiac dysfunction and heart failure in hematopoietic cell transplantation survivors: Emerging paradigms in pathophysiology, screening, and prevention. Heart Fail Clin. 2017;13(2):337-45. [Crossref] [PubMed]
- Akahori M, Nakamae H, Hino M, Yamane T, Hayashi T, Ohta K, et al. Electrocardiogram is very useful for predicting acute heart failure following myeloablative chemotherapy with hematopoietic stem cell transplantation rescue. Bone Marrow Transplant. 2003;31(7): 585-90. [Crossref] [PubMed]
- Peres E, Levine JE, Khaled YA, Ibrahim RB, Braun TM, Krijanovski OI, et al. Cardiac compli ca tions in patients undergoing a reduced-inten sity conditioning hematopoietic stem cell transplantation. Bone Marrow Transplant. 2010;45(1): 149-52. [Crossref] [PubMed] [PMC]
- Olivieri A, Corvatta L, Montanari M, Brunori M, Offidani M, Ferretti GF, et al. Paroxysmal atrial fibrillation after high-dose melphalan in five patients autotransplanted with blood progenitor cells. Bone Marrow Transplant. 1998;21(10): 1049-53. [Crossref] [PubMed]
- Mathur P, Paydak H, Thanendrarajan S, van Rhee F. Atrial Fibrillation in Hematologic Malignancies, Especially After Autologous Hema topoietic Stem Cell Transplantation: Review of Risk Factors, Current Management, and Future Directions. Clin Lymphoma Mye loma Leuk. 2016;16(2):70-5. [Crossref] [PubMed]
- Özdöver AC, Gündeş İ, Kırık MP, Haydaroğlu Şahin H, Sucu M, Pehlivan M. Evaluation of cardiac parameters in bone marrow transplant patients: Effect of pulmonary artery pressure on survival. Turk J Haematol. 2019;36(1):19-24. [Crossref] [PubMed] [PMC]
- Dandoy CE, Hirsch R, Chima R, Davies SM, Jodele S. Pulmonary hypertension after hematopoietic stem cell transplantation. Biol Blood Marrow Transplant. 2013;19(11):1546-56. [Crossref] [PubMed]
.: İşlem Listesi