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Background: Cardiac evaluation during first 100 days after stem cell transplant (SCT) is usually performed only if clinically indicated, however, patients with mild left ventricular (LV) dysfunction can be asymptomatic. Scheduled post-SCT screening at day 100 may identify patients with subacute cardiac toxicity identified as LV dysfunction.
Methods: We conducted a single center prospective study to screen for LV dysfunction after SCT in 100 consecutive patients. Patients received echocardiography screening prior to SCT and 100 days post-SCT. Patients were classified as having LV dysfunction if echocardiography met at least one of the following criteria: (1) ejection fraction (EF) 50% or less, (2) fractional shortening (FS) two standard deviations below the age adjusted mean, (3) >10% decrease in EF or FS at day 100 from baseline.
Results: 92 of 100 consecutive patients completed day 100 screening (8 died). 25% (23 of 92) had LV dysfunction at day 100 (Table). 96%(22 of 23) were asymptomatic at time of screening. Patients with LV dysfunction were older at the time of SCT than those without (p=0.068). Patients receiving PBSC grafts had an increased incidence of LV dysfunction (p= 0.032), likely related to the diagnosis of those patients (malignancy receiving autologous SCT and Fanconi Anemia). Overall, however, diagnosis was not significantly associated with LV dysfunction. Patients with previous anthracycline exposure had increased LV dysfunction compared to those without (48% vs. 26%). GVHD, engraftment syndrome, and viremias in the first 100 days were not significantly associated with decreased RV function. Death at 1 year was similar in both groups.
Discussion:
25% of patients showed signs of cardiac dysfunction at day 100, which was higher than anticipated. Although there were no acute differences in outcome, the long-term complications are unknown. Echocardiography at day 100 identifies SCT cardiac dysfunction, however, more research is needed to understand the overall impact on long-term outcome.
Table
| LV Dysfunction at day +100 (n=23)
| No LV Dysfunction at day +100 (n=69)
| p value
|
Male
| 14 (61%)
| 47 (68%)
| 0.61
|
Mean Age in Yrs (95% CI) | 9.6 (6.3-12.9)
| 6.9 (5.5-8.2)
| 0.068
|
Diagnosis
|
| 0.36
| |
Malignancy
| 12 (51%)
| 22 (32%)
|
|
Immune deficiency
| 5 (21%)
| 29 (42%)
|
|
Bone Marrow Failure
| 5 (21%)
| 15 (22%)
|
|
Genetic/Metabolic
| 1 (7%)
| 2 (3%)
|
|
Benign Hematology
| 0
| 1 (1%)
|
|
Therapy / Conditioning
|
| ||
Previous anthracycline
| 11 (48%)
| 18 (26%)
| 0.070
|
RIC
| 12 (52%)
| 42 (61%)
| 0.47
|
Myeloablative
| 11 (48%)
| 27 (39%)
|
|
Donor
|
| 0.11
| |
Autologous
| 7 (30%)
| 9 (13%)
|
|
Allogeneic
| 16 (70%)
| 60 (87%)
|
|
Source
|
| 0.032
| |
Bone Marrow
| 11 (48%)
| 43 (62%)
|
|
Cord
| 0
| 8 (12%)
|
|
PBSC
| 12 (52%)
| 18 (26%)
|
|
Type
|
| 0.14
| |
Auto
| 7 (30%)
| 9 (13%)
|
|
Related Donor
| 3 (13%)
| 8 (12%)
|
|
Unrelated Donor
| 13 (57%)
| 52 (75%)
|
|
Transplant Complications
|
| ||
GVHD
| 5 (22%)
| 26 (38%)
| 0.21
|
Engraftment Syndrome
| 1 (4%)
| 11 (16%)
| 0.28
|
Adenovirus
| 4 (17%)
| 12 (17%)
| 1.00
|
CMV
| 3 (13%)
| 19 (28%)
| 0.26
|
EBV
| 7 (30%)
| 31 (45%)
| 0.33
|
Death at 1 year
| 5 (22%)
| 14 (20%)
| 1.00
|