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Transplant Toxicities

Arrhythmias in the setting of hematopoietic cell transplants

Bone Marrow Transplantation volume 50, pages 1212–1216 (2015)Cite this article

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Abstract

Prior studies report that 9–27% of persons receiving a hematopoietic cell transplant develop arrhythmias, but the effect on outcomes is largely unknown. We reviewed data from 1177 consecutive patients ⩾40 years old receiving a hematopoietic cell transplant at one center during 1999–2009. Transplant indication was predominately leukemia, lymphoma and multiple myeloma. Overall, 104 patients were found to have clinically significant arrhythmia: 43 before and 61 after transplant. Post-transplant arrhythmias were most frequently atrial fibrillation (N=30), atrial flutter (N=7) and supraventricular tachycardia (N=11). Subjects with an arrhythmia post transplant were more likely to have longer median hospital stays (32 days vs 23, P=<0.001), a greater probability of an intensive care unit admission (52% vs 7%; P<0.001), greater probability of in-hospital deaths (28% vs 3%, P<0.001), and greater probability of death within 1 year of transplant (41% vs 15%; P<0.001) compared with patients without arrhythmia at any time. In a multivariate model including age at transplant, diagnosis, history of pretransplant arrhythmia, and transplant-related variables, post-transplant arrhythmia was associated with a greater risk for death within a year of transplant (odds ratio 3.5, 95% confidence interval: 2.1, 5.9; P<0.001). Our data suggest that arrhythmias after transplants are associated with significant morbidity and mortality. A prospective study of arrhythmia in the transplant setting is warranted.

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Acknowledgements

This work was supported by research grants from the American Cancer Society (ACS CCCDA 11-192-01), the American Institute for Cancer Research, and the National Institutes of Health (R01CA187397).

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Authors and Affiliations

  1. Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USA

    E S Tonorezos, E E Stillwell, R M Steingart, A A Jakubowski & W L Schaffer

  2. Department of Medicine, Weill Cornell Medical College, New York, NY, USA

    E S Tonorezos, A Pham, R M Steingart, A A Jakubowski & W L Schaffer

  3. Department of Medicine, Hospital for Special Surgery, New York, NY, USA

    J J Calloway

  4. Department of Medicine, Beth Israel Medical Center, New York, NY, USA

    T Glew

  5. Department of Medicine, New York Presbyterian-Columbia, New York, NY, USA

    J D Wessler

  6. Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA

    B J Rebolledo

  7. Department of Medicine, UH Case Medical Center, Cleveland, OH, USA

    H Lazarus

  8. Division of Experimental Medicine, Department of Medicine, Haematology Research Centre, Imperial College London, London, UK

    R P Gale

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  1. E S Tonorezos
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Correspondence to W L Schaffer.

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Tonorezos, E., Stillwell, E., Calloway, J. et al. Arrhythmias in the setting of hematopoietic cell transplants. Bone Marrow Transplant 50, 1212–1216 (2015). https://doi.org/10.1038/bmt.2015.127

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