Severe cardiotoxic characteristics associated with allogeneic hematopoietic stem cell transplantation preconditioning in patients with aplastic anemia
10.3760/cma.j.cn112138-20240522-00333
- VernacularTitle:再生障碍性贫血患者异基因造血干细胞移植预处理相关严重心脏毒性特点分析
- Author:
Xue MING
1
;
Yuanyuan ZHANG
;
Tingting HAN
;
Jingzhi WANG
;
Xiaodong MO
;
Fengrong WANG
;
Chenhua YAN
;
Yu WANG
;
Yuhong CHEN
;
Zhengli XU
;
Feifei TANG
;
Ting ZHAO
;
Kaiyan LIU
;
Xiaohui ZHANG
;
Xiaojun HUANG
;
Lanping XU
Author Information
1. 北京大学人民医院 北京大学血液病研究所 国家血液系统疾病临床研究中心 造血干细胞移植治疗血液病北京市重点实验室，北京 100044
- Keywords:
Anemia, aplastic;
Allogeneic hematopoietic stem cell transplantation;
Cyclophosphamide;
Cardiotoxicity
- From:
Chinese Journal of Internal Medicine
2024;63(11):1096-1103
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To delineate the clinical characteristics and outcomes associated with severe cardiac toxicity during the preconditioning phase of allogeneic hematopoietic stem cell transplantation (allo-HSCT) in patients with aplastic anemia (AA).Methods:This retrospective case series study included 31 patients with severe AA who underwent allo-HSCT and were diagnosed with severe cardiac toxicity at the Hematology Department of Peking University People′s Hospital from August 2012 to June 2022. The clinical manifestations of severe cardiac toxicity observed during the preconditioning process were assessed. Patient survival was assessed using the Kaplan-Meier method.Results:In this cohort of 31 patients, the median follow-up period was 9 days (range: 4-365 days). Severe cardiac toxicity manifested within 6 days after the initial cyclophosphamide (Cy) administration. Twenty patients died within 30 days of initiating Cy preconditioning, of which 16 patients died due to severe cardiac toxicity within 25 days. Patients whose cardiac function improved within 30 days post-preconditioning showed a median survival duration of 222 days ( n=11). Troponin I (TNI) levels in patients who died within 30 days of initiating Cy preconditioning began increasing on day 5 post-Cy, peaking sharply by day 9 after a notable rise on day 8. B-type natriuretic peptide (BNP) levels in patients who died within 30 days of initiating Cy preconditioning started to rise from day 1, stabilized between days 2 and 5, and then doubled daily from days 6 to 8, remaining elevated thereafter. Notably, the initial increases in BNP and TNI correlated with electrocardiogram (ECG) signs of low voltage and T-wave inversion in 83.87% of cases ( n=26). Most patients ( n=28, 90.32%) were administered corticosteroid therapy. In those with restored cardiac function, the ejection fraction returned to >50% within 30 days of initiating Cy preconditioning. Conclusions:Patients with severe cardiac toxicity during the preconditioning phase of allo-HSCT typically exhibit early, sustained, and marked elevations in myocardial damage markers, including BNP and TNI, accompanied by ECG abnormalities following Cy administration, with BNP often increasing first. These indicators are associated with rapid disease progression and high mortality. Prompt initiation of treatment upon clinical diagnosis is critical for improving survival outcomes.
