Related Experiment Videos
Effects of bone marrow transplantation on myocardial function in children
J Pihkala1, U M Saarinen, U Lundström
1Children's Hospital, University of Helsinki, Finland.
Insights
Pediatric bone marrow transplant (BMT) patients experienced acute and late cardiotoxicity. Long-term cardiac follow-up is crucial for survivors of total body irradiation and BMT therapies.
Area of Science:
- Pediatric Oncology
- Cardiology
- Hematology
Background:
- Bone marrow transplantation (BMT) is a life-saving procedure for pediatric patients.
- Total body irradiation (TBI) and chemotherapy regimens are common pre-transplant therapies.
- Potential long-term side effects, including cardiotoxicity, require investigation.
Purpose of the Study:
- To evaluate the incidence and characteristics of acute and late cardiotoxicity in pediatric patients following BMT.
- To assess the impact of different pre-transplant regimens on cardiac function.
- To determine the need for long-term cardiac monitoring in BMT survivors.
Main Methods:
- Study included 30 pediatric patients post-BMT (allogeneic and autologous).
- Pre-transplant therapies included cyclophosphamide (CY), TBI, and other agents.
- Cardiac function assessed via ECG, chest radiograph, radionuclide cineangiography (RNCA), and echocardiography (ECHO) at median 5 years post-transplant.
Main Results:
- All patients showed acute cardiotoxicity indicated by decreased QRS voltage sum.
- Six patients had persistent QRS amplitude decrease and abnormal systolic function.
- BMT patients exhibited impaired systolic and diastolic myocardial function compared to controls.
- Myocardial damage was most severe after CY; high-dose Ara C was best tolerated.
Conclusions:
- Both acute and late cardiotoxicity are significant risks following pediatric BMT.
- Long-term cardiac surveillance is essential for BMT survivors.
- Specific chemotherapy agents differentially impact cardiac health post-transplant.
Abstract:
Of 41 pediatric patients currently alive after total body irradiation (TBI) and bone marrow transplantation (BMT), 30 (allogeneic 20, autologous 10) participated in the study. Pre-transplant therapy included high-dose cyclophosphamide (CY) and TBI (n = 12), high-dose CY alone (n = 4), high-dose Ara C and TBI (n = 5), cisplatinum, high-dose melphalan, VP-16 and TBI (n = 9). Acute cardiotoxicity was suggested by a > 15% decrease in the QRS voltage sum of the limb leads in all patients. Late cardiotoxicity was evaluated 0.5-10 years (median 5 years) post-transplant by ECG, chest radiograph, radionuclide cineangiography (RNCA) and echocardiography (ECHO). Six patients had a persistent decrease in the QRS amplitudes. They were all asymptomatic but had abnormal systolic function at the time of the study. BMT patients differed from their controls in the mean values of both the systolic and diastolic indices of myocardial function shown by RNCA and ECHO. Treatment was associated with decreased myocardial contractility. Isovolumic relaxation time and deceleration time were longer in BMT patients than in controls. Myocardial damage seemed to be worst after CY while high-dose Ara C was tolerated best. We conclude that both acute and late cardiotoxicity may occur after BMT, calling for long-term cardiac follow-up.