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Autografting

Autologous hematopoietic stem cell transplantation in systemic lupus erythematosus patients with cardiac dysfunction: feasibility and reversibility of ventricular and valvular dysfunction with transplant-induced remission

Bone Marrow Transplantation volume 40, pages 47–53 (2007)Cite this article

Abstract

Patients with cardiac dysfunction may be at increased risk of cardiac toxicity when undergoing hematopoietic stem cell transplantation (HSCT), which may preclude them from receiving this therapy. Cardiac dysfunction is, however, common in systemic lupus erythematosus (SLE) patients. While autologous HSCT (auto-HSCT) has been performed increasingly for SLE, its impact on cardiac function has not previously been evaluated. We, therefore, performed a retrospective analysis of SLE patients who had undergone auto-HSCT in our center to determine the prevalence of significant cardiac involvement, and the impact of transplantation on this. The records of 55 patients were reviewed, of which 13 were found to have abnormal cardiac findings on pre-transplant two-dimensional echocardiography or multi-gated acquisition scan: impaired left ventricular ejection fraction (LVEF) (n=6), pulmonary hypertension (n=5), mitral valve dysfunction (n=3) and large pericardial effusion (n=1). At a median follow-up of 24 months (8–105 months), there were no transplant-related or cardiac deaths. With transplant-induced disease remission, all patients with impaired LVEF remained stable or improved; while three with symptomatic mitral valve disease similarly improved. Elevated pulmonary pressures paralleled activity of underlying lupus. These data suggest that auto-HSCT is feasible in selected patients with lupus-related cardiac dysfunction, and with control of disease activity, may improve.

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References

  1. Doria A, Iaccarino L, Sarzi-Puttini P, Atzeni F, Turriel M, Petri M . Cardiac involvement in systemic lupus erythematosus. Lupus 2005; 14: 683–686.

    Article  CAS  Google Scholar 

  2. Mandell BF . Cardiovascular involvement in systemic lupus erythematosus. Semin Arthritis Rheum 1987; 17: 126.

    Article  CAS  Google Scholar 

  3. Moder KG, Miller TD, Tazellar HD . Cardiac involvement in systemic lupus erythematosus. Mayo Clin Proc 1999; 74: 275.

    Article  CAS  Google Scholar 

  4. Bearman SI, Petersen FB, Schor RA, Denney JD, Fisher LD, Appelbaum FR et al. Radionuclide ejection fractions in the evaluation of patients being considered for bone marrow transplantation: risk for cardiac toxicity. Bone Marrow Transplant 1990; 3: 173–177.

    Google Scholar 

  5. Hertenstein BM, Schmeiser ST, Scholz M, Gdller V, Clausen M, Bunjes D et al. Cardiac toxicity of bone marrow transplantation: predictive value of cardiologic evaluation before transplant. J Clin Oncol 1994; 12: 998–1004.

    Article  CAS  Google Scholar 

  6. Marmont AM, van Lint MT, Gualandi F, Bacigalupo A . Autologous marrow stem cell transplantation for severe systemic lupus erythematosus of long duration. Lupus 1997; 6: 545–548.

    Article  CAS  Google Scholar 

  7. Burt RK, Traynor A, Statkute L, Barr WG, Rosa R, Schroeder J et al. Nonmyeloablative hematopoietic stem cell transplantation for systemic lupus erythematosus. JAMA 2006; 295: 527–535.

    Article  CAS  Google Scholar 

  8. Tan EM, Cohen AS, Fries JF, Masi AT, McShane DJ, Rothfield NF et al. The 1982 revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum 1982; 25: 1271–1277.

    Article  CAS  Google Scholar 

  9. Bombardier C, Gladman DD, Urowitz MB, Caron D, Chang DH, the Committee on Prognosis Studies in SLE. Derivation of the SLEDAI: a disease activity index for lupus patients. Arthritis Rheum 1992; 35: 630–640.

    Article  CAS  Google Scholar 

  10. The Criteria Committee of the New York Heart Association. Nomenclature and Criteria for Diagnosis of Diseases of the Heart and Great Vessels, 9th edn. Little, Brown & Co: Boston, MA, 1994, pp 253–256.

  11. Roldan CA, Shively BK, Lau CC, Gurule FT, Smith EA, Crawford MH . Systemic lupus erythematosus valve disease by transesophageal echocardiography and the role of antiphospholipid antibodies. J Am Coll Cardiol 1992; 20: 1127–1134.

    Article  CAS  Google Scholar 

  12. Manzi S, Meilahn EN, Rairie JE, Conte CG, Medsger Jr TA, Jansen-McWilliams L et al. Age-specific incidence rates of myocardial infarction and angina in women with systemic lupus erythematosus: comparison with the Framingham study. Am J Epidemiol 1997; 145: 408.

    Article  CAS  Google Scholar 

  13. Galve E, Candell-Riera J, Pigrau C, Permanyer-Miralda G, Garcia-del-Castillo H, Soler-Soler J . Prevalence, morphologic types, and evolution of cardiac valvular disease in systemic lupus erythematosus. N Eng J Med 1988; 319: 817–823.

    Article  CAS  Google Scholar 

  14. Roldan CA, Shively BK, Crawford MH . An echocardiographic study of valvular heart disease associated with systemic lupus erythematosus. N Engl J Med 1996; 335: 1424–1430.

    Article  CAS  Google Scholar 

  15. Perez-Villa F, Font J, Azqueta M, Espinosa G, Pare C, Cervera R et al. Severe valvular regurgitation and antiphospholipid antibodies in systemic lupus erythematosus: a prospective, long-term, followup study. Arthritis Rheum 2005; 53: 460–467.

    Article  Google Scholar 

  16. Appelbaum FR, Strauchen JA, Graw RG, Savage DD, Kent KM, Ferrans VJ 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 

  17. Sakata-Yanagimoto M, Kanda Y, Nakagawa M, Asano-Mori Y, Kandabashi K, Izutsu K et al. Predictors for severe cardiac complications after hematopoietic stem cell transplantation. Bone Marrow Transplant 2004; 33: 1043–1047.

    Article  CAS  Google Scholar 

  18. Fujimaki K, Maruta A, Yoshida M, Sakai R, Tanabe J, Koharazawa H et al. Severe cardiac toxicity in hematological stem cell transplantation: predictive value of reduced left ventricular ejection fraction. Bone Marrow Transplant 2001; 27: 307–310.

    Article  CAS  Google Scholar 

  19. Saccardi R, Tyndall A, Coghlan G, Denton C, Edan G, Emdin M et al. Consensus statement concerning cardiotoxicity occurring during haematopoietic stem cell transplantation in the treatment of autoimmune diseases, with special reference to systemic sclerosis and multiple sclerosis. Bone Marrow Transplant 2004; 34: 877–881.

    Article  CAS  Google Scholar 

  20. Wijetunga M, Rockson S . Myocarditis in systemic lupus erythematosus. Am J Med 2002; 113: 419–423.

    Article  Google Scholar 

  21. Cervera R, Font J, Pare C, Azqueta M, Perez-Villa F, Lopez-Soto A et al. Cardiac disease in systemic lupus erythematosus: prospective study of 70 patients. Ann Rheum Dis 1992; 51: 156–159.

    Article  CAS  Google Scholar 

  22. Schattner A, Liang MH . The cardiovascular burden of lupus: a complex challenge. Arch Intern Med 2003; 163: 1507–1510.

    Article  Google Scholar 

  23. Law WG, Thong BY, Lian TY, Kong KO, Chng HH . Acute lupus myocarditis: clinical features and outcome of an oriental case series. Lupus 2005; 14: 827–831.

    Article  CAS  Google Scholar 

  24. Chan YK, Li EK, Tam LS, Chow LTC, Ng HK . Intravenous cyclophosphamide improves cardiac dysfunction in lupus myocarditis. Scand J Rheumatol 2003; 32: 306–308.

    Article  CAS  Google Scholar 

  25. Traynor AE, Schroeder J, Rosa RM, Cheng D, Stefka J, Mujais S et al. Treatment of severe systemic lupus erythematosus with high-dose chemotherapy and haemopoietic stem-cell transplantation: a phase I study. Lancet 2000; 356: 701–707.

    Article  CAS  Google Scholar 

  26. Traynor AE, Barr WG, Rosa RM, Rodriguez J, Oyama Y, Baker S et al. Hematopoietic stem cell transplantation for severe and refractory lupus. Analysis after five years and fifteen patients. Arthritis Rheum 2002; 46: 2917–2923.

    Article  Google Scholar 

  27. Gottdiener JS, Appelbaum FR, Ferrans VJ, Deisseroth A, Ziegler J . Cardiotoxicity associated with high-dose cyclophosphamide therapy. Arch Intern Med 1981; 141: 758–763.

    Article  CAS  Google Scholar 

  28. Lee CK, Harman GS, Hohl RJ, Gingrich RD . Fatal cyclophosphamide cardiomyopathy: its clinical course and treatment. Bone Marrow Transplant 1996; 18: 573–577.

    CAS  PubMed  Google Scholar 

  29. Statkute L, Traynor A, Oyama Y, Yaung K, Verda L, Krosnjar N et al. Antiphospholipid syndrome in patients with systemic lupus erythematosus treated by autologous hematopoietic stem cell transplantation. Blood 2005; 106: 2700–2709.

    Article  CAS  Google Scholar 

  30. Tanaka E, Harigai M, Tanaka M, Kawaguchi Y, Hara M, Kamatani N . Pulmonary hypertension in systemic lupus erythematosus: evaluation of clinical characteristics and response to immunosuppressive treatment. J Rheumatol 2002; 29: 282–287.

    PubMed  Google Scholar 

  31. Gonzalez-Lopez L, Cardona-Munoz EG, Celis A, Garcia-de la Torre I, Orozco-Barocio G, Salazar-Paramo M et al. Therapy with intermittent pulse cyclophosphamide for pulmonary hypertension associated with systemic lupus erythematosus. Lupus 2004; 13: 105–112.

    Article  CAS  Google Scholar 

  32. Klinkhoff AV, Thompson CR, Reid GD, Tomlinson CW . M-mode and two-dimensional echocardiographic abnormalities in systemic lupus erythematosus. JAMA 1985; 253: 3273–3277.

    Article  CAS  Google Scholar 

  33. Man BL, Mok CC . Serositis related to systemic lupus erythematosus: prevalence and outcome. Lupus 2005; 14: 822–826.

    Article  CAS  Google Scholar 

  34. Weich HS, Burgess LJ, Reuter H, Brice EA, Doubell AF . Large pericardial effusions due to systemic lupus erythematosus: a report of eight cases. Lupus 2005; 14: 450–457.

    Article  CAS  Google Scholar 

  35. Kahl LE . The spectrum of pericardial tamponade in systemic lupus erythematosus. Report of ten patients. Arthritis Rheum 1992; 35: 1343–1349.

    Article  CAS  Google Scholar 

  36. Traynor AE, Corbridge TC, Eagan AE, Barr WG, Liu Q, Oyama Y et al. Prevalence and reversibility of pulmonary dysfunction in refractory systemic lupus: improvement correlates with disease remission following hematopoietic stem cell transplantation. Chest 2005; 127: 1680–1689.

    Article  Google Scholar 

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Authors and Affiliations

  1. Division of Immunotherapy, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA

    Y Loh, Y Oyama, L Statkute, J Satkus, K Quigley, K Yaung, J Bucha & R K Burt

  2. Department of Medicine, Maine General Medical Center, Waterville, ME, USA

    A Traynor

  3. Division of Rheumatology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA

    W Barr

  4. Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA

    M Gheorghiade

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  1. Y Loh
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Correspondence to R K Burt.

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Loh, Y., Oyama, Y., Statkute, L. et al. Autologous hematopoietic stem cell transplantation in systemic lupus erythematosus patients with cardiac dysfunction: feasibility and reversibility of ventricular and valvular dysfunction with transplant-induced remission. Bone Marrow Transplant 40, 47–53 (2007). https://doi.org/10.1038/sj.bmt.1705698

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  • DOI: https://doi.org/10.1038/sj.bmt.1705698

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