Large pericardial effusion as a complication in adults undergoing SCT

Area of Science:

• Hematology
• Transplantation Immunology
• Cardiology

Background:

• Large pericardial effusion (LPE) leading to cardiac tamponade is a rare complication post-stem cell transplant (SCT).
• The pathophysiology of LPE in SCT recipients, potentially linked to chronic graft-versus-host disease (GVHD), is not well understood.
• Limited data exist on the incidence, clinical features, and outcomes of LPE in adult SCT patients.

Purpose of the Study:

• To retrospectively evaluate the incidence, clinical characteristics, and outcomes of LPE in adult patients undergoing SCT.
• To identify risk factors and patient populations associated with the development of post-transplant LPE.

Main Methods:

• Retrospective analysis of 858 adult patients (autologous, related, and unrelated donor SCT) from 2005 to 2008.
• Evaluation for the development of post-transplant LPE.
• Review of clinical data, GVHD status, interventions (pericardial window), and treatment outcomes.

Main Results:

• Seven patients (0.8%) developed LPE, all of whom received unrelated allografts.
• LPE was diagnosed at a median of 229 days post-transplant (range 42-525 days).
• No patients had active GVHD manifestations other than serositis at LPE diagnosis; pericardial window placement was successful, and LPE was managed by increasing immunosuppression.

Conclusions:

• Large pericardial effusion is a rare late complication, observed exclusively after unrelated allogeneic SCT in this adult cohort.
• Pericardial window procedures are safe and effective for managing cardiac tamponade due to LPE.
• Intensification of systemic immunosuppression is a successful treatment strategy for LPE in SCT recipients.