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Acute myocardial infarction in a 16-year-old girl with chronic GVHD

Bone Marrow Transplantation volume 45, pages 1576–1577 (2010)Cite this article

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Cardiovascular complications are important causes of morbidity and mortality among BMT recipients. The preparative regimen for allogeneic BMT and long-term immunosuppression can induce atherosclerosis; in addition, the coronary endothelium is a potential target for the graft-versus-host immune response in chronic GVHD.1 A 16-year-old girl with chronic GVHD developed acute myocardial infarction 3 years after BMT. Coronary angiography revealed total occlusion of the right coronary artery, which was recanalized using percutaneous coronary intervention. Multiple stenoses and proximal ectasia of the left and right coronary arteries were also observed, suggesting an immune-mediated vascular injury, that is, an endothelial form of chronic GVHD. Cardiovascular risk assessment is essential after BMT, especially in patients with chronic GVHD.

Our patient was diagnosed with aplastic anemia at 3 years of age. At 13 years, she was diagnosed with myelodysplastic syndrome (refractory cytopenia with multilineage dysplasia); subsequently, she underwent BMT with BM harvested from her mother. The grafts were HLA mismatched at two loci and ABO mismatched; the patient was administered 1.18 × 108 nucleated cells/kg. The preparative regimen comprised TBI, and fludarabine and melphalan administration. She also received tacrolimus for GVHD prophylaxis. After BMT, hemolytic uremic syndrome and systemic human herpesvirus 6 infection occurred as complications. The latter was successfully treated with ganciclovir. A skin biopsy specimen obtained on day 113 after BMT showed evidence of GVHD. Chronic GVHD was initially treated with CyA and azathioprine, and 4 months later, with CyA monotherapy. The CMV serostatus of the donor and recipient were compatible with previous infection, and no evidence for either CMV replication or reactivation was observed after BMT.

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Authors and Affiliations

  1. Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan

    T Miura, A Izawa, S Kumazaki, K Otagiri, K Aizawa, M Koshikawa, H Kasai, T Tomita, Y Miyashita, H Tsutsui, J Koyama & U Ikeda

  2. Department of General Medicine, Nagano Children's Hospital, Nagano, Japan

    E Ishii

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  1. T Miura
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  2. A Izawa
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  3. S Kumazaki
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  7. M Koshikawa
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  11. H Tsutsui
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  12. J Koyama
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  13. U Ikeda
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Correspondence to A Izawa.

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Miura, T., Izawa, A., Kumazaki, S. et al. Acute myocardial infarction in a 16-year-old girl with chronic GVHD. Bone Marrow Transplant 45, 1576–1577 (2010). https://doi.org/10.1038/bmt.2010.21

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