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 Complications

Severe cardiac toxicity in hematological stem cell transplantation: predictive value of reduced left ventricular ejection fraction

Abstract

Eighty patients receiving hematological stem cell transplantation (HCT) with a preparative regimen consisting of total body irradiation (12.5 Gy), cyclophosphamide (4000 or 4500 mg/m2), and thiotepa (400 mg/m2) were evaluated for the development of cardiac toxicity. Patients in whom the pretransplant cumulative dose of anthracycline was more than or equal to 300 mg/m2 showed a lower left ventricular ejection fraction (EF) before HCT compared to patients with less than 300 mg/m2 (0.61 ± 0.09 vs0.67 ± 0.06, P = 0.0010). Patients who had undergone more than or equal to six courses of chemotherapy showed a decreased EF before HCT compared to those after less than six courses (0.67 ± 0.05 vs0.63 ± 0.09, P = 0.03). Three of seven patients (43%) whose pretransplant EF had been less than or equal to 0.55 developed severe cardiac toxicity, characterized by congestive heart failure (CHF) compared with none of 83 patients (0%) whose pretransplant EF had been more than 0.55 (P = 0.00026). Of the three patients who developed severe cardiac toxicity, two were given more than 300 mg/m2 of cumulative anthracycline and underwent 23 courses and six courses of chemotherapy, while the other patient received only two courses of chemotherapy with a total dose of 139 mg/m2 of anthracycline. These results indicate that an increased cumulative dose of anthracycline and number of chemotherapy treatments are correlated with a decrease of the EF and that the EF before HCT is useful for predicting the risk of cardiac complications for recipients who have received chemotherapy. Bone Marrow Transplantation (2001) 27, 307–310.

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

Access options

Rent or buy this article

Prices vary by article type

from$1.95

to$39.95

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

Figure 1
Figure 2
Figure 3

Similar content being viewed by others

References

  1. Appelbaum F, Strauchen JA, Graw RG et al. Acute lethal carditis caused by high-dose combination chemotherapy. A unique clinical and pathological entity Lancet 1976 1: 58–62

    Article  CAS  Google Scholar 

  2. Gottdiener JS, Applebaum FR, Ferrans VJ et al. Cardiotoxicity associated with high-dose combination chemotherapy Arch Intern Med 1981 141: 758–763

    Article  CAS  Google Scholar 

  3. Bristow MR, Billingham ME, Mason JW et al. Clinical spectrum of anthracycline antibiotic cardiotoxicity Cancer Treat Rep 1978 62: 1114–1118

    Google Scholar 

  4. Bearman SI, Petersen FB, Schor RA et al. Radionuclide ejection fractions in the evaluation of patients being considered for bone marrow transplantation: risk for cardiac toxicity Bone Marrow Transplant 1990 5: 173–177

    CAS  Google Scholar 

  5. Hertenstein B, Stefanic M, Schmeiser T et al. Cardiac toxicity of bone marrow transplantation: predictive value of cadiologic evaluation before transplant J Clin Oncol 1994 5: 998–1004

    Article  Google Scholar 

  6. Goldberg MA, Antin JH, Guinan EC, Rappeport JM . Cyclophosphamide cardiotoxicity: an analysis of dosing as a risk factor Blood 1986 68: 1114–1118

    CAS  Google Scholar 

  7. von Hoff DD, Layard MW, Basa P et al. Risk factors for doxorubicin-induced congestive heart failure Ann Intern Med 1979 91: 710–717

    Article  CAS  Google Scholar 

  8. von Hoff DD, Rozencweig M, Layard M et al. Daunomycin-induced cadiotoxicity in children and adults: a review of 110 cases Am J Med 1977 62: 200–208

    Article  CAS  Google Scholar 

  9. Dukart G . Cardiac events in patients receiving mitoxantrone. In: Smith JF (ed.) A Comprehensive Guide to the Therapeutic Use of Novantrone PharmaLibri: Chicago 1984 pp 65–74

    Google Scholar 

  10. Herait P, Poutignat N, Marty M, Bugat R . Early assessment of a new drug analogue: are the historical comparisons obsolete? The French experience with pirarubicin Eur J Cancer 1992 28A: 1670–1676

    Article  CAS  Google Scholar 

  11. Anderlini P, Benjamin RS, Wong FC et al. Idarubicin cardiotoxicity: a retrospective study in acute myeloid leukemia and myelodysplasia J Clin Oncol 1995 13: 2827–2834

    Article  CAS  Google Scholar 

  12. Hori S, Shirai M, Hirano S et al. Antitumor activity of new anthracycline antibiotics, Aclacinomycin-A and its analogs and their toxicity Gann 1977 68: 685–690

    CAS  PubMed  Google Scholar 

  13. Singal PK, Iliskovic N . Doxorubicin-induced cardiomyopathy New Engl J Med 1998 24: 900–905

    Article  Google Scholar 

  14. Baello EB, Ensberg ME, Ferguson DW et al. Effect of high-dose cyclophosphamide and total-body irradiation on left ventricular function in adult patients with leukemia undergoing allogeneic bone marrow transplantation Cancer Treat Rep 1986 70: 1187–1193

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Fujimaki, K., Maruta, A., Yoshida, M. et al. Severe cardiac toxicity in hematological stem cell transplantation: predictive value of reduced left ventricular ejection fraction. Bone Marrow Transplant 27, 307–310 (2001). https://doi.org/10.1038/sj.bmt.1702783

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/sj.bmt.1702783

Keywords

This article is cited by

Search

Quick links