Cardiovascular function in children following bone marrow transplant: a cross-sectional study

Area of Science:

• Cardiology
• Pediatric Oncology
• Hematology

Background:

• Bone marrow transplantation (BMT) is a life-saving treatment for pediatric cancers and other diseases.
• Long-term survivors of pediatric BMT require ongoing monitoring for treatment-related late effects.
• Cardiac complications are a significant concern following BMT, particularly in childhood recipients.

Purpose of the Study:

• To assess the long-term prevalence, types, severity, and risk factors of cardiac abnormalities in pediatric BMT survivors.
• To evaluate cardiac function and identify potential predictors of cardiac dysfunction in this population.
• To determine the necessity of continued, serial cardiac evaluation in BMT survivors.

Main Methods:

• Cross-sectional evaluation of 63 patients who underwent BMT at age 18 or younger, at least 1 year post-transplant.
• Comprehensive cardiac assessment including history, resting ECG, echocardiography (ECHO), exercise treadmill test, and review of prior cardiac studies.
• Patients were categorized by New York Heart Association (NYHA) functional class based on symptoms and activity levels.

Main Results:

• 41.3% of patients had a cardiac abnormality detected post-BMT, with 21 new findings not present pre-transplant.
• Resting ECG abnormalities were found in 16.4% of patients; ECHO showed mild to marked decreases in LVEF in 4 patients.
• 74% of patients aged 9+ had abnormal or borderline exercise treadmill test responses; 12.7% were symptomatic (NYHA class II/III).
• No correlation found between demographic factors, prior therapy, preparative regimen, or follow-up duration and cardiac abnormalities.
• Symptom presence and NYHA class predicted exercise oxygen consumption and overall treadmill results.

Conclusions:

• Late cardiac abnormalities are common in pediatric BMT survivors, necessitating long-term surveillance.
• Exercise stress testing is vital for detecting inadequate cardiac output and reduced oxygen consumption during exercise.
• Serial cardiac evaluations, including exercise testing, are essential for managing BMT survivors and improving long-term outcomes.