Haematopoietic stem cell transplantation (HCT) is the treatment of choice for defined malignant and non-malignant haematological disorders. Patients (pts) treated by chemotherapy are at increased risk of developing cardiovascular complications. Few studies to date have evaluated the association between pre-HCT and HCT therapeutic exposures, and the risk of HF post-HCT. We evaluated the role of patient demographics, pre-HCT therapeutic exposures, transplantation conditioning regimens, and post-HCT therapy in the development of HF after HCT.
Methods: A total of 40 consecutive patients who underwent HCT for a hematologic malignancy between December 2011 and September 2012 were recruited and followed prospectively. The information collected included: demographics, disease status at HCT, conditioning-related exposures, and post-HCT cardiac function and clinical functional capacity.
Results: Of the 40 patients in the cohort, 24 (58%) were males. The mean age at transplantation was 47 years (range, 18 to 69 years). Twenty nine patients (71%) were treated with anthracycline chemotherapy pre HCT. During hospitalization 35 pts (87%) had elevated BNP level (25 pts had BNP 100-400 pg/ml; 10 pts had BNP>400 pg/ml), but only 4 patients were at NYHA FC 2 or higher. Three pts had slightly elevated troponin level, 2 pts had left ventricular ejection fraction (LVEF) less than 50% and 5 pts had diastolic dysfunction. Thirty one pts (77%) had echocardiography at 1-6 months of follow-up but only 2 patient showed LVEF of less than 50%. During 412 days of follow-up 12 pts (30%) died not from heart failure.
Conclusions: These data show that short-term survivors after HCT do not have reduction in left ventricular systolic function. Although many pts have elevated BNP during HCT hospitalization, their LVEF is normal, and the reason for elevated BNP may be fluid overload that pts get during HCT.
