Summary:
Endocarditis is an uncommon complication of hematopoietic stem cell transplantation (HSCT). A retrospective review of 1547 patients who underwent HSCT in Vancouver between January 1986 and December 2001 was performed. In all, 20 cases of endocarditis were identified (1.3% of all patients) with nine patients having received cryopreserved autologous stem cells, six stem cells from a histocompatible sibling and five patients stem cells from an unrelated donor. Five patients had endocarditis diagnosed while alive, a median of 6 months post-HSCT, by transthoracic (four patients) or transesophageal (one patient) echocardiography. The remaining 15 cases of endocarditis were only identified post mortem. The mitral valve was the most frequently involved (10 patients) followed by the aortic valve (six patients); multivalvular disease was noted in five patients. Of the 11 affected allogeneic HSCT patients, 10 had previously developed acute graft-versus-host disease (GVHD). Causative organisms were identified in 11 patients, while nine additional cases were felt to be thrombotic in origin. Of the 20 patients, 19 died with the sole survivor alive 10 years following an aortic valve replacement. Endocarditis is an uncommon complication of HSCT usually involving the cardiac valves on the left side of the heart and is associated with a high mortality rate.
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References
Van der Meer JWM, Guiot HFL, van den Broek PJ, Van Furth R . Infections in bone marrow transplant recipients. Semin Hematol 1984; 21 (Suppl. 2): 123–2140.
Noel DR, Witherspoon RP, Storb R et al. Does graft-versus-host disease influence the tempo of immunologic recovery after allogeneic human marrow translantation? An observation on 56 long-term survivors. Blood 1978; 51: 1087–1105.
Storek J, Witherspoon RP . Immunologic reconstitution after hematopoietic stem cell transplantation. In: Atkinson K (ed.). Clinical Bone Marrow and Blood Stem Cell Transplantation. Cambridge University Press, Cambridge, UK, 2000; pp 111–146.
Safdar A, Childs BH, Keefe D, Sepkowitz K . Acute bacterial endocarditis during granulocytopenia in an allogeneic marrow transplant recipient. Am J Med 2000; 109: 514–515.
Cancelas JA, Lopez J, Cabezudo E et al. Native valve endocarditis due to Candida parapsilosis: a late complication after bone marrow transplantation-related fungemia. Bone Marrow Transplant 1994; 13: 33–34.
Rao K, Sah V . Medical management of Aspergillus flavus endocarditis. Pediatr Hematol Oncol 2000; 17: 425–427.
Martino P, Micozzi A, Venditti M et al. Catheter-related right-sided endocarditis in bone marrow transplant recipients. Rev Infect Dis 1990; 15: 500–502.
Vukelja SJ, Baker WJ, Jeffreys P et al. Nonbacterial thrombotic endocarditis clinically mimicking veno-occlusive disease of the liver complicating autologous bone marrow transplantation. Am J Clin Oncol 1992; 15 (Suppl. 6): 500–502.
Gordon BG, Haire WD, Patton DF et al. Thrombotic complications of BMT: association with protein C deficiency. Bone Marrow Transplant 1993; 11 (Suppl. 1): 61–65.
Patchell RA, White CL, Clark AW et al. Nonbacterial thrombotic endocarditis in bone marrow transplant patients. Cancer 1985; 55: 631–635.
Chandrasekar PH, Weinmann A, Shearer C . Autopsy-identified infections among bone marrow transplant recipients: a clinico-pathologic study of 56 patients. Bone Marrow Transplant 1985; 16: 675–681.
Kupari M, Volin L, Suokas A et al. Cardiac involvement in bone marrow transplantation: electrocardiographic changes, arrhythmias, heart failure and autopsy findings. Bone Marrow Transplant 1990; 5: 91–98.
Durack DT, Lukes AS, Bright DK . New criteria for diagnosis of infective endocarditis: utilization of specific echocardiographic findings. Am J Med 1994; 96 (Suppl. 3): 200–209.
Arnow PM, Quimosing EM, Beach M . Consequences of intravascular catheter sepsis. Clin Infect Dis 1993; 16 (Suppl. 6): 778–784.
Lopez JA, Ross RS, Fishbein MC, Seigel RJ . Nonbacterial thrombotic endocarditis: a review. Am Heart J 1987; 113 (Suppl. 3): 773–784.
Deppisch LM, Fayemi AO . Non-bacterial thrombotic endocarditis: clinicopathological correlations. Am Heart J 1976; 92 (Suppl. 6): 723–729.
Haire WD, Lieberman RP, Edney J et al. Hickman catheter-induced thoracic vein thrombosis. Frequency and long-term sequelae in patients receiving high-dose chemotherapy and marrow transplantation. Cancer 1990; 66 (Suppl. 5): 900–908.
Carreras E . Veno-occlusive disease of the liver after hemopoietic cell transplantation. Eur J Haematol 2000; 64 (Suppl. 5): 281–291.
Fuge R, Bird JM, Fraser A et al. The clinical features, risk factors and outcome of thrombotic thrombocytopenic purpura occuring after bone marrow transplantation. Br J Haematol 2000; 113: 58–64.
Leblond V, Salehian BD, Borel C et al. Alterations in natural anticoagulant levels during allogeneic bone marrow transplantation: a prospective study in 27 patients. Bone Marrow Transplant 1993; 4: 299–305.
Buja LM, Ferrans VJ, Graw RGJ . Cardiac pathologic findings in patients treated with bone marrow transplantation. Hum Pathol 1976; 7 (Suppl. 1): 17–45.
Vannucchi AM, Longo G, Bosi A et al. Early haemostatic modifications following cryopreserved graft infusion. Bone Marrow Transplant 1991; 8 (Suppl. 3): 171–176.
Acknowledgements
We acknowledge the contributions of the medical and nursing staff of Tower 15A Ward and BMT Daycare at the Vancouver General Hospital and the staff of 6 West at the British Columbia Cancer Agency.
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Kuruvilla, J., Forrest, D., Lavoie, J. et al. Characteristics and outcome of patients developing endocarditis following hematopoietic stem cell transplantation. Bone Marrow Transplant 34, 969–973 (2004). https://doi.org/10.1038/sj.bmt.1704655
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DOI: https://doi.org/10.1038/sj.bmt.1704655
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