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Cardiac toxicity of bone marrow transplantation: predictive value of cardiologic evaluation before transplant
B Hertenstein1, M Stefanic, T Schmeiser
1Department of Internal Medicine III (Hematology and Oncology), University of Ulm, Germany.
Insights
Life-threatening cardiac toxicity is rare after bone marrow transplantation (BMT), affecting less than 2% of patients. While reduced ejection fraction (EF) before BMT correlates with minor cardiac events, it doesn
Area of Science:
- Cardiology
- Hematology
- Oncology
Background:
- Bone marrow transplantation (BMT) is a critical treatment for various hematologic and oncologic conditions.
- Cardiac complications represent a significant concern for patients undergoing BMT.
- Assessing pre-transplant cardiac risk is crucial for patient management.
Purpose of the Study:
- To analyze the incidence of cardiac complications following BMT.
- To evaluate the predictability of individual cardiac risk before BMT.
- To investigate the relationship between pre-transplant cardiac status and post-transplant cardiac toxicity.
Main Methods:
- 170 patients undergoing allogeneic or autologous BMT were assessed.
- Pre-BMT evaluations included physical examination, ECG, echocardiography, and radionuclide ventriculography (RNV).
- Patients were monitored for cardiac toxicity for 3 months post-BMT.
Main Results:
- Overall cardiac toxicity occurred in 4.7% of patients; life-threatening toxicity in 1.8%.
- Reduced left ventricular ejection fraction (EF) before BMT correlated with minor cardiac events (P < .05).
- No significant correlation was found between pre-BMT cardiac findings and life-threatening toxicity.
Conclusions:
- Life-threatening cardiac toxicity is infrequent after BMT.
- While reduced EF is linked to minor cardiac events, it does not reliably predict severe toxicity.
- Individual prediction of life-threatening cardiac toxicity remains challenging.
Purpose:
This study analyses the risk of cardiac complications and its individual predictability in bone marrow transplantation (BMT).
Patients And Methods:
One hundred seventy patients undergoing allogeneic (n = 150) or autologous (n = 20) BMT were evaluated by physical examination, history, rest and exercise ECG, chest x-ray, two-dimensional echocardiography, and radionuclide ventriculography (RNV) before BMT, and monitored for 3 months thereafter.
Results:
Following BMT, cardiac toxicity occurred in eight patients (4.7%). Three patients (1.8%) developed life-threatening toxicity (pericardial effusion and left ventricular failure, n = 2; sudden cardiac arrest, n = 1). Thirty-eight patients (22%) had pathologic findings before BMT. In 22 patients, left ventricular ejection fraction (EF) determined by RNV was reduced to less than 55%. This was the only abnormality in 17 patients and was generally mild, with a lowest EF of 42%. There was no correlation between overall results of cardiologic evaluation before BMT and cardiac toxicity. Cardiotoxic events occurred more frequently in patients with a reduced EF (P < .05). However, this was restricted to minor cardiac events. Life-threatening cardiac toxicity was not significantly increased in patients with pathologic results before BMT. Moreover, none of the patients with an EF less than 50% developed cardiac toxicity.
Conclusion:
Life-threatening cardiac toxicity is rare after BMT, occurring in less than 2% of all patients. Although the occurrence of cardiac toxicity is correlated with a reduction of EF before BMT, life-threatening cardiac toxicity cannot be predicted in individual patients.