Cardiac adverse events during stem cell transplantation for hematological malignancies: A single centre experience

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Abstract

Hematopoietic stem cell transplantation (HSCT) is a highly successful treatment option for many hematological malignancies. Several adverse effects can be seen in HSCT due to the infusion and damage caused by the conditioning regimens. Cardiovascular adverse effects are relatively common during HSCT, and they have the potential to cause devastating complications. The aim of present study was to evaluate the transplantation-related cardiac adverse effects and determine the risk factors in patients undergoing HSCT at our institution. A retrospective analysis has been performed in 662 patients who was treated at Hacettepe University Stem Cell Transplantation Unit. Amongst the 622 patients, 318 (51.1 %) underwent autologous and 304 (48.9 %) underwent allogeneic HSCT. The frequency of the cardiac adverse effects was found to be 10.8 % in all the study population. The most common adverse effect was tachyarrhythmia, constituting 7.9 % of all population. These adverse effects were mostly occurred in lymphoma patients (14 %). Nineteen (3.0 %) of all patients developed atrial fibrillation mostly on the 4th day (range of 1–9 days) after transplantation. Life-threatening events are extremely rare. These adverse effects appear to be related to the type of transplantation rather than the underlying disease. Therefore, close follow-up of patients is important during the peri-transplantation period.

Introduction

Hematopoietic stem cell transplantation (SCT) is a curative and highly successful treatment option for many hematological malignancies [1]. Several adverse effects can be seen both in autologous and allogeneic SCT due to the infusion and damage caused by the transplantation conditioning regimens. Infusion-related adverse effects during the autologous transplantation have generally been linked to dimethyl sulfoxide (DMSO) which is used as cryoprotectant. [2], [3], [4].

Cardiovascular adverse effects are relatively common during SCT, and they have the potential to cause devastating complications [5]. These effects have also been known to increase the long-term incidence of co-morbidity. However, the etiology and predisposing factors of cardiovascular adverse effects are not clearly defined [6].

The aim of the present study was to evaluate the transplantation-related cardiac adverse effects and determine the risk factors in patients receiving autologous and allogeneic SCT at our institution.

Section snippets

Study design and patient selection

A retrospective analysis of 622 consecutive patients with hematological malignancies, received autologous or allogeneic SCT, followed at the Hacettepe University Department of Haematology Stem Cell Transplantation Unit between 2005 and 2019 were enrolled. Medical history, physical examination, systolic and diastolic blood pressure (BP) measurements, demographic characteristics including age, gender, and body mass index, smoking status, creatinine level and transplantation related data including

Results

Baseline demographic characteristics, laboratory findings, disease status, and infusion related parameters of all population and autologous and allogeneic SCT groups are presented in Table 1. Of 622 patients, 318 (51.1 %) received autologous and 304 (48.9 %) received allogeneic SCT. The most commonly transplanted disease was acute leukemia with 244 (39.2 %) patients followed by multiple myeloma with 233 (37.5 %) patients. Then, 107 (17.2 %), 30 (4.8 %), and 8 (1.3 %) patients received SCT due

Discussion

The purpose of the present study was to evaluate the cardiac adverse events during SCT in patients with hematologic malignancies. The incidence of cardiac adverse events that consist of hypertension, hypotension / bradycardia, tachyarrhythmia and cardiac arrest was found to be 10.8 %. In addition, the most common adverse effect was tachyarrhythmia and no difference was found between hematologic malignancies regarding these cardiac adverse events.

Cardiac adverse events may be seen during SCT

Conclusion

Cardiac adverse events are relatively common during SCT; however, life-threatening events are extremely rare. These adverse effects appear to be related to the type of transplantation rather than the underlying disease. Patients undergoing SCT should be closely monitored during the peri-transplantation period to identify the cardiac adverse events early to minimize the risks of subsequent complications. In our institution, in the pre-transplantation period, patients with high risk for

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