Persistent heart failure following melphalan and fludarabine conditioning

Advances in chemotherapy and radiotherapy have greatly improved cancer survival, but their side effects can sometimes be more dangerous than the cancer itself. Understanding these risks is especially important when the consequences are as life-threatening as heart failure. Melphalan and fludarabine are drugs used in many chemotherapy regimens and are not usually associated with cardiotoxicity. In this report we present a patient that developed acute heart failure followed by persistent heart failure after conditioning with these drugs following a bone marrow transplant. <Learning objective: The chemotherapeutic agents melphalan and fludarabine used individually are rarely associated with cardiotoxicity. However, this case report of myocarditis and persistent heart failure, adds to the growing literature suggesting an exponential rise in cardiac complications when these agents are used in combination. Awareness of this association is important to consider when choosing and monitoring a chemotherapy regimen.>.