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.

  • Letter to the Editor
  • Published:

Acute and fatal cardiotoxicity following high-dose cyclophosphamide in a patient undergoing autologous stem cell transplantation for systemic sclerosis despite satisfactory cardiopulmonary screening

Bone Marrow Transplantation volume 52, pages 1674–1677 (2017)Cite this article

Subjects

Autologous stem cell transplantation (ASCT) using high-dose cyclophosphamide (HD CYC) is currently the best therapeutic approach for early rapidly progressive systemic sclerosis (SSc) with diffuse skin and/or visceral involvement.1, 2 The importance of a careful disease specific pre-transplantation evaluation of cardiopulmonary involvement has been recently emphasized to reduce treatment-related mortality.1, 2, 3

We report a case of acute heart failure following ASCT, related to histologically proven CYC cardiotoxicity in a rapidly progressive SSc without any evidence of SSc-related cardiopathy or pulmonary arterial hypertension (PAH) prior to transplant.

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

References

  1. van Laar JM, Farge D, Sont JK, Naraghi K, Marjanovic Z, Larghero J et al. Autologous hematopoietic stem cell transplantation vs intravenous pulse cyclophosphamide in diffuse cutaneous systemic sclerosis: a randomized clinical trial. JAMA 2014; 311: 2490.

    Article  CAS  Google Scholar 

  2. Burt RK, Shah SJ, Dill K, Grant T, Gheorghiade M, Schroeder J et al. Autologous non-myeloablative haemopoietic stem-cell transplantation compared with pulse cyclophosphamide once per month for systemic sclerosis (ASSIST): an open-label, randomised phase 2 trial. Lancet 2011; 378: 498–506.

    Article  CAS  Google Scholar 

  3. Snowden JA, Saccardi R, Allez M, Ardizzone S, Arnold R, Cervera R et al. Haematopoietic SCT in severe autoimmune diseases: updated guidelines of the European Group for Blood and Marrow Transplantation. Bone Marrow Transplant 2012; 47: 770–790.

    Article  CAS  Google Scholar 

  4. Katayama M, Imai Y, Hashimoto H, Kurata M, Nagai K, Tamita K et al. Fulminant fatal cardiotoxicity following cyclophosphamide therapy. J Cardiol 2009; 54: 330–334.

    Article  Google Scholar 

  5. Atalay F, Gulmez O, Ozsancak Ugurlu A . Cardiotoxicity following cyclophosphamidetherapy: a case report. J Med Case Reports 2014; 8: 252.

    Article  Google Scholar 

  6. Morandi P, Ruffini PA, Benvenuto GM, Raimondi R, Fosser V . Cardiac toxicity of high-dose chemotherapy. Bone Marrow Transplant 2005; 35: 323–334.

    Article  CAS  Google Scholar 

  7. Dadfarmay S, Berkowitz R, Kim B . Irreversible end-stage cardiomyopathy following a single dose of cyclophosphamide. Congest Heart Fail 2012; 18: 234–237.

    Article  Google Scholar 

  8. Senkus E, Jassem J . Cardiovascular effects of systemic cancer treatment. Cancer Treat Rev 2011; 37: 300–311.

    Article  CAS  Google Scholar 

  9. Raccor BS, Claessens AJ, Dinh JC, Park JR, Hawkins DS, Thomas SS et al. Potential contribution of cytochrome P450 2B6 to hepatic 4-hydroxycyclophosphamide formation in vitro and in vivo. Drug Metab 2012; 40: 54–63.

    Article  CAS  Google Scholar 

  10. Nishikawa T, Miyahara E, Kurauchi K, Watanabe E, Ikawa K, Asaba K et al. Mechanisms of fatal cardiotoxicity following high-dose cyclophosphamide therapy and a method for its prevention. PLoS ONE 2015; 10: e0131394.

    Article  Google Scholar 

  11. Himmel HM . Drug-induced functional cardiotoxicity screening in stem cell-derived human and mouse cardiomyocytes: effects of reference compounds. J Pharmacol Toxicol Methods 2013; 68: 97–111.

    Article  CAS  Google Scholar 

  12. Burt RK, Oliveira MC, Shah SJ, Moraes DA, Simoes B, Gheorghiade M et al. Cardiac involvement and treatment-related mortality after non-myeloablative haemopoietic stem-cell transplantation with unselected autologous peripheral blood for patients with systemic sclerosis: a retrospective analysis. Lancet 2013; 381: 1116–1124.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Clinical Immunology, National Referral Center for Autoimmune Diseases, Strasbourg University Hospital, Strasbourg, France

    M Martin & T Martin

  2. Department of Hematology, Strasbourg University Hospital, Strasbourg, France

    L-m Fornecker

  3. Department of Anatomopathology, Strasbourg University Hospital, Strasbourg, France

    L Marcellin

  4. Department of Cardiovascular Radiology, Hopital Européen Georges Pompidou, Paris, France

    E Mousseaux

  5. Internal Medicine and Vascular Disease Unit, AP-HP Saint-Louis Hôpital, Paris Denis Diderot University, Paris, France

    A Hij & D Farge

  6. Department of Haematology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK

    J A Snowden

  7. Department of Oncology & Metabolism, University of Sheffield, Sheffield, UK

    J A Snowden

Authors
  1. M Martin
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. L-m Fornecker
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. L Marcellin
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. E Mousseaux
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. A Hij
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. J A Snowden
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. D Farge
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. T Martin
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to M Martin.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Martin, M., Fornecker, Lm., Marcellin, L. et al. Acute and fatal cardiotoxicity following high-dose cyclophosphamide in a patient undergoing autologous stem cell transplantation for systemic sclerosis despite satisfactory cardiopulmonary screening. Bone Marrow Transplant 52, 1674–1677 (2017). https://doi.org/10.1038/bmt.2017.188

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/bmt.2017.188

This article is cited by

Search

Advanced search

Quick links