Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Post-Transplant Events

Very acute cardiac toxicity during BEAC chemotherapy in non-Hodgkin's lymphoma patients undergoing autologous stem cell transplantation

Bone Marrow Transplantation volume 36, pages 1077–1082 (2005)Cite this article

Summary:

Cardiotoxicity is potentially the most threatening nonhaematological side effect of high-dose CY. We prospectively evaluated the very acute cardiac effects of high-dose CY in 17 adult non-Hodgkin's lymphoma (NHL) patients receiving CY 1500 mg/m2/day as a part of BEAC high-dose therapy (HDT). Magnetic resonance imaging (MRI) and plasma natriuretic peptide (NT-proBNP, NT-proANP) measurements were performed prior to HDT (d-7) and just after completing HDT (d-2). After the high-dose CY left atrial end-systolic area increased from 15.2±1.2 to 18.5±1.4 cm2 (P=0.001), left ventricular end-diastolic volume from 136.1±12.3 to 156.6±11.1 cm3 (P=0.04) and left ventricular end-systolic volume from 67.4±7.8 to 75.3±7.1 cm3 (P=0.018). However, no significant change in left ventricular ejection fraction (LVEF) was observed. At the same time, plasma levels of NT-proBNP increased from 134.9±53.3 to 547.1±168.4 pmol/l (P=0.003) and NT-proANP from 481.1±105.5 to 1056.6±193.1 pmol/l (P=0.001), respectively. To conclude, high-dose CY results in very acute cardiac toxicity characterised by enlargement of the heart chambers in NHL patients previously treated with anthracyclines. This toxicity can be detected with increased concentrations of circulating natriuretic peptides but not with LVEF measurement.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1
Figure 2

Similar content being viewed by others

References

  1. Gratwohl A, Schmid O, Baldomero H et al. Haematopoietic stem cell transplantation (HSCT) in Europe 2002. Changes in indications and impact of team density. A report of the EBMT activity survey. Bone Marrow Transplant 2004; 34: 855–875.

    Article  CAS  PubMed  Google Scholar 

  2. Cazin B, Gorin NC, Laporte JP et al. Cardiac complications after bone marrow transplantation. A report on a series of 63 consecutive transplantations. Cancer 1986; 57: 2061–2069.

    Article  CAS  PubMed  Google Scholar 

  3. Gottdiener J, Appelbaum F, Ferrans V et al. Cardiotoxicity associated with high-dose cyclophosphamide therapy. Arch Intern Med 1981; 141: 758–763.

    Article  CAS  PubMed  Google Scholar 

  4. Kupari M, Volin L, Suokas T et al. Cardiac involvement in bone marrow transplantation: electrocardiographic changes, arrhythmias, heart failure and autopsy findings. Bone Marrow Transplant 1990; 5: 91–98.

    CAS  PubMed  Google Scholar 

  5. Appelbaum F, Strauchen JA, Grew Jr RG et al. Acute lethal carditis caused by high-dose combinationchemotherapy. Lancet 1976; 1: 58–62.

    Article  CAS  PubMed  Google Scholar 

  6. Murdych T, Weisdorf DJ . Serious cardiac complications during bone marrow transplantation at the University of Minnesota, 1977–1997. Bone Marrow Transplant 2001; 28: 283–287.

    Article  CAS  PubMed  Google Scholar 

  7. Braverman A, Antin J, Plappert M et al. Cyclophosphamide cardiotoxicity in bone marrow transplantation: a prospective evaluation of new dosing regimens. J Clin Oncol 1991; 9: 1215–1223.

    Article  CAS  PubMed  Google Scholar 

  8. Morandi P, Ruffini PA, Benvenuto GM et al. Serum cardiac troponin I levels and ECG/Echo monitoring in breast cancer patients undergoing high-dose (7 g/m2) cyclophosphamide. Bone Marrow Transplant 2001; 28: 277–282.

    CAS  PubMed  Google Scholar 

  9. Hertenstein B, Stefanic M, Schmeiser T et al. Cardiac toxicity of bone marrow transplantation: predictive value of cardiac evaluation before transplant. J Clin Oncol 1994; 12: 998–1004.

    Article  CAS  PubMed  Google Scholar 

  10. Morandi P, Ruffini PA, Benvenuto GM et al. Cardiac toxicity of high-dose chemotherapy. Bone Marrow Transplant 2005; 35: 323–334.

    Article  CAS  PubMed  Google Scholar 

  11. Snowden JA, Hill GR, Hunt P et al. Assessment of cardiotoxicity during haematopoietic stem cell transplantation with plasma brain natriuretic peptide. Bone Marrow Transplant 2000; 26: 309–313.

    Article  CAS  PubMed  Google Scholar 

  12. Niwa N, Watanabe E, Hamaguchi M et al. Early and late elevation of plasma atrial and brain natriuretic peptides in patients after bone marrow transplantation. Ann Hematol 2001; 80: 460–465.

    Article  CAS  PubMed  Google Scholar 

  13. Bellenger NG, Burgess MI, Ray SG et al. Comparison of left ventricular ejection fraction and volumes in heart failure by echocardiography, radionuclide ventriculography and cardiovascular magnetic resonance: are they interchangeable? Eur Heart J 2000; 21: 1387–1396.

    Article  CAS  PubMed  Google Scholar 

  14. Harris NL, Jaffe ES, Diebold J et al. World Health Organisation classification of neoplastic diseases of the hematopoietic and lymphoid tissues: report of the clinical advisory committee meeting – Airlie House, Virginia, November 1997. J Clin Oncol 1999; 17: 3835–3849.

    Article  CAS  PubMed  Google Scholar 

  15. The International non-Hodgkin's Lymphoma Prognostic Factor Project. A predictive model for aggressive non-Hodgkin's lymphoma. N Engl J Med 1993; 329: 987–994.

  16. Dulce M, Mostbeck G, Friese K et al. Quantification of left ventricular volumes and function with cine MR imaging: comparison of geometric models with three-dimensional data. Cardiac Radiol 1993; 188: 371–376.

    CAS  Google Scholar 

  17. Constantine G, Shan K, Flamm S et al. Role of MRI in clinical cardiology. Lancet 2004; 363: 2162–2171.

    Article  PubMed  Google Scholar 

  18. Ala-Kopsala M, Magga J, Peuhkurinen K et al. Molecular heterogeneity has a major impact on the measurements of circulating N-terminal fragments of A- and B-type natriuretic peptides. Clin Chem 2004; 50: 1576–1588.

    Article  CAS  PubMed  Google Scholar 

  19. Kazanegra R, Cheng V, Garcia A et al. A rapid test for B-type natriuretic peptide correlates corraltes with falling wedge pressures in patinets treated for decompensated heart failure: a pilot study. J Card Fail 2001; 7: 21–29.

    Article  CAS  PubMed  Google Scholar 

  20. Taniguchi I . Clinical significance of cyclophosphamide-induced cardiotoxicity. J Intern Med 2005; 44: 89–90 (Editorial).

    Article  Google Scholar 

  21. Herman E, Lipshultz S, Ferrens V . The use of biomarkers to detect myocardial damage induced by chemotherapy agents. In: Wu AHB (ed.). Cardiac markers. Humana Press Incl, 2004, pp 87–109.

    Google Scholar 

  22. Nousiainen T, Jantunen E, Vanninen E et al. Natriuretic peptides as markers of cardiotoxicity during doxorubicin treatment for non-Hodgkin's lymphoma. Eur J Haematol 1999; 62: 135–141.

    Article  CAS  PubMed  Google Scholar 

  23. Daugaard G, Lassen U, Bie P et al. Natriuretic peptides in the monitoring of anthracycline induced reduction in left ventricular ejection fraction. Eur J Heart Failure 2005; 7: 87–93.

    Article  CAS  Google Scholar 

  24. Kremer LC, van Dalen EC, Offringa M et al. Anthracycline-induced clinical heart failure in a cohort of 607 children: long-term follow-up study. J Clin Oncol 2000; 19: 191–196.

    Article  Google Scholar 

Download references

Acknowledgements

This study was supported by a Grant of the Finnish Society of Haematology and EVO funding from the Kuopio University Hospital.

Author information

Authors and Affiliations

  1. Department of Medicine, Kuopio University Hospital, Kuopio, Finland

    T Kuittinen, T Nousiainen, E Jantunen & J Hartikainen

  2. Department of Radiology, Kuopio University Hospital, Kuopio, Finland

    M Husso-Saastamoinen & P Sipola

  3. Department of Physiology, University of Oulu, Biocenter Oulu, Oulu, Finland

    O Vuolteenaho & M Ala-Kopsala

Authors
  1. T Kuittinen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M Husso-Saastamoinen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. P Sipola
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. O Vuolteenaho
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. M Ala-Kopsala
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. T Nousiainen
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. E Jantunen
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. J Hartikainen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to T Kuittinen.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kuittinen, T., Husso-Saastamoinen, M., Sipola, P. et al. Very acute cardiac toxicity during BEAC chemotherapy in non-Hodgkin's lymphoma patients undergoing autologous stem cell transplantation. Bone Marrow Transplant 36, 1077–1082 (2005). https://doi.org/10.1038/sj.bmt.1705175

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/sj.bmt.1705175

Keywords

This article is cited by

Search

Advanced search

Quick links