Cardiac systolic function before and after hematopoietic stem cell transplantation
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Published on: May 25, 2020
S Lehmann1, B Isberg, P Ljungman
1Department of Hematology, Huddinge University Hospital, Sweden.
Insights
Hematopoietic stem cell transplantation (HSCT) does not significantly impact cardiac systolic function, as measured by left ventricular ejection fraction (LVEF). This study found no significant changes in LVEF post-transplant in patients undergoing HSCT.
Area of Science:
- Cardiology
- Hematology
- Oncology
Background:
- Hematopoietic stem cell transplantation (HSCT) is a critical treatment for various hematologic malignancies and other diseases.
- Potential cardiotoxicity from prior treatments (e.g., anthracyclines) and the transplantation procedure itself necessitates evaluation of cardiac function post-HSCT.
- Left ventricular ejection fraction (LVEF) is a key indicator of cardiac systolic function.
Purpose of the Study:
- To assess the impact of HSCT on cardiac systolic function.
- To evaluate changes in LVEF before and after HSCT in a diverse patient cohort.
- To identify any patient subgroups or pre-transplant factors associated with changes in cardiac function.
Main Methods:
- Prospective measurement of LVEF using radioventriculography (RVG) in 148 patients before and after HSCT.
- Subgroup analysis based on transplant type (allogeneic vs. autologous) and primary diagnosis (CML, AML, ALL, multiple myeloma, breast cancer).
- Correlation analysis with prior anthracycline exposure and long-term clinical follow-up for heart failure.
Main Results:
- Mean LVEF remained stable post-HSCT (60.2% pre vs. 61.1% post) across the entire cohort.
- No significant changes in LVEF were observed in any diagnostic subgroup or between allogeneic and autologous recipients.
- Patients with prior anthracycline exposure had lower pre-transplant LVEF but did not experience a greater decline post-HSCT.
Conclusions:
- HSCT procedure does not appear to adversely affect myocardial systolic function in the 1-7 month period following transplantation.
- Cardiac function remains stable despite prior treatments like anthracyclines in patients undergoing HSCT.
- Long-term follow-up showed no clinical heart failure development in the studied patient population.
Abstract:
In order to examine the effect of hematopoietic stem cell transplantation (HSCT) on cardiac systolic function, we measured left ventricular ejection fraction (LVEF) by radioventriculography (RVG) before and after the transplantation procedure. One hundred and forty-eight patients were examined, 96 undergoing allogeneic grafting and 52 autologous. Fifty patients had CML, 48 AML, 21 ALL, 18 multiple myeloma and 11 breast cancer. The second RVG examination was performed 22 to 227 days (median 60 days) after HSCT. The mean LVEF value in the whole patient group was 60.2% (range 39-81%) before and 61.1% (35-86%) after transplantation. Patients with CML had significantly higher LVEF before transplantation than patients with acute leukemia (P = 0.007) and multiple myeloma (P = 0.005). No significant changes in mean LVEF between the pre- and post-transplant measurements were seen in any of the diagnostic subgroups or in allogeneic or autologous recipients. None of the 148 patients in the study has shown any signs of clinical heart failure at 2, 5 to 10 years follow-up. Patients who had received anthracyclines in the previous treatment had significantly lower LVEF before transplantation but showed no increased risk of decline in cardiac function. In conclusion, the HSCT procedure does not seem to affect myocardial function 1-7 months after transplantation.
