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Coronary artery disease following bone marrow transplantation
K W Chan1, G P Taylor, J D Shepherd
1Department of Paediatrics, University of British Columbia, Canada.
Insights
A young woman developed severe coronary artery disease and myocardial infarction after allogeneic bone marrow transplantation for leukemia. This case highlights a potential link between bone marrow transplants and cardiac complications.
Area of Science:
- Cardiology
- Hematology
- Oncology
Background:
- Allogeneic bone marrow transplantation (BMT) is a curative therapy for refractory leukemia.
- Chemotherapy (daunorubicin) and high-dose conditioning (cyclophosphamide, total body irradiation) are standard BMT protocols.
- Graft-versus-host disease (GVHD) is a common complication following allogeneic BMT.
Observation:
- A 19-year-old woman with refractory leukemia underwent allogeneic BMT.
- Post-transplant, she developed severe, therapy-resistant chronic GVHD affecting the skin.
- Thirty months post-BMT, she experienced sudden death.
Findings:
- Postmortem examination revealed severe coronary artery disease (CAD) and acute myocardial infarction (MI).
- The patient had a history of daunorubicin chemotherapy prior to BMT.
- Conditioning regimen included high-dose cyclophosphamide and 1260 cGy total body irradiation.
Implications:
- This case suggests a potential association between allogeneic BMT and the development of severe CAD/MI.
- Cardiovascular complications should be considered in the long-term follow-up of BMT survivors.
- Further research is warranted to elucidate the mechanisms linking BMT and cardiac disease.
Abstract:
A 19-year-old woman died suddenly 30 months after allogeneic bone marrow transplantation for refractory leukemia. On postmortem examination severe coronary artery disease and acute myocardial infarction were found. The patient had previously been given chemotherapy including daunorubicin for treatment of her leukemia. She received high dose cyclophosphamide and total body irradiation (1260 cGy) for her transplant. Diffuse chronic graft-versus-host disease, mainly affecting skin, subsequently developed, and was resistant to various therapies. The possible association of coronary artery disease and allogeneic bone marrow transplantation is discussed.