Evaluation of lymphoma patients after hematopoetic stem cell transplantation in terms of early period cardiotoxicity development

Year 2023, Volume: 9 Issue: 1, 1 - 7, 04.01.2023

Sedat Çelikçi , Vildan Ozkocaman , Fatih Yaman , Fahir Özkalemkaş

https://doi.org/10.18621/eurj.889233

Cited By: 1

Abstract

Objectives: Autologous hematopoietic stem cell transplant (AHSCT) following high-dose chemotherapy in recurrent lymphomas has become the standard treatment. However, this method leads to various toxic side effects, including cardiotoxicity. This study aims to determine the factors that may cause post-transplant cardiotoxicity.

Methods: A total of 35 patients older than 18 years old, diagnosed with recurrent lymphoma, who underwent AHSCT at the Uludağ University Hematology Department, were included in the study. The patients were evaluated in two groups, with and without cardiotoxicity after AHSCT. We separated the frequency of cardiotoxicity that developed during hospitalization after transplantation and patients who developed and did not develop cardiotoxicity. We compare some parameters including gender, age, lymphoma type, stage, cardiac risk factors before transplantation, the number of chemotherapy cycles and the use of rituximab before the transplantation, radiotherapy before transplantation, Karnofsky performance scale, the amount of Dimethyl sulfoxide among these patients. Also, we evaluated patients with echocardiopraphy before transplantation and measured left ventricle ejection fraction (LVEF). We use CTCAE V 4.0 system for evaluating cardiotoxicity level from Grade I to Grade V.

Results: Nine patients developed cardiac events. One patient developed Grade V MI and died despite treatment. Other eight toxicities developed Grade III-IV and returned by treatment. In terms of risk factors, LVEF of the group with cardiotoxicity was found to be significantly low (p < 0.05). There is no statistical difference between the two groups with other parameters.

Conclusions: Cardiotoxicity is a frequent complication of autologous stem cell transplantation. A detailed pre-transplantation evaluation of all patents in terms of cardiac functions is essential to reduce cardiac morbidity. Therefore, patients should be evaluated cardiologically before transplantation and closely monitored for post-transplantation cardiac side effects. Some studies show that enalapril and carvedilol may be beneficial to prevent from cardiotoxicity. Although not in our routine, if approved by larger studies, it may be necessary to use agents such as enalapril and carvedilol in prophylaxis in reduce cardiotoxicity.

Keywords

stem cell transplantation, cardiotoxicity, lymphoma, chemotherapy

References

• 1. Ferlay J, Shin H, Bray F, Forman D, Mathers C, Parkin DM. Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer 2010;127:2893-917.
• 2. Muller AM, Ihorst G, Mertelsmann R, Engelhardt M. Epidemiology of non-Hodgkin's lymphoma (NHL): trends, geographic distribution, and etiology. Ann Hematol 2005 84:1-12.
• 3. Braverman AC, Antin JH, Plappert MT, Cook EF, Lee Rt. Cyclophosphamide cardiotoxicity: a prospective evaluation of new dosing regimens. J Clin Oncol 1991;9:1215-23.
• 4. Alidina A, Lawrence D, Ford LA, Baer MR, Bambach B, Bernstein SH, et al. Thiotepa-associated cardiomyopathy during blood or marrow transplantation: association with female sex and cardiac risk factors. Biol Blood Marrow Tranplant 1999;5:322-7.
• 5. Alessandrino EP, Bernasconi P, Caldera D, Colombo A, Bonfichi M, Malcovati L, et al. Adverse events occurring during bone marrow or peripheral blood progenitor cell infusion: analysis of 126 cases. Bone Marrow Transplant 1999;23:533-7.
• 6. Türk Kardiyoloji Derneği, Koroner Kalp Hastalığından Korunma ve Tedaviye İlişkin Ulusal Kılavuz 1995.
• 7. Common Terminology Criteria for Adverse Events v4.0 (CTCAE), 2009.
• 8. Oken MM, Creech RH, Tormey DC, Horton J, Davis TE, McFadden ET, et al. Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am J Clin Oncol 1982;5:649-55.
• 9. Linch DC, Winfield D, Goldstone AH, Moir D, Hancock B, McMillan A, et al. Dose intensification with autologous bone-marrow transplantation in relapsed and resistent Hodgkin's disease: results of a BNLI randomised trial. Lancet 1993;341:1051-4.
• 10. Copelan EA. Hematopoietic stem-cell transplantation. N Engl J Med 2006;354:1813-26.
• 11. Armenian SH, Sun CL, Francisco L, et al. Late congestive heart failure (CHF) following hematopoietic cell transplantation (HCT). 44th Annual Meeting of the American Society of Clinical Oncology 2008.
• 12. Murdych T, Weisdorf DJ. Serious cardiac complications during bone marrow transplantation at the University of Minnesota 1977-1997. Bone Marrow Transplant 2001;28:283-7.
• 13. Hidalgo JD, Krone R, Rich MW, Blum K, Adkins D, Fan M-Y, et al, Supraventricular tachyarrhythmias after hematopoietic stem cell transplantation: incidence, risk factors and outcomes. Bone Marrow Transplant 2004;34:615-9.
• 14. Tichelli A, Bhatia S, Socie G. Cardiac and cardiovascular consequences after haematopoietic stem cell transplantation. Br J Haematol 2008;142:11-26.
• 15. Hershman DL, McBride RB, Eisenberger A, Tsai WY, Grann VR, Jacobson JS. Doxorubicin, cardiac risk factors, and cardiac toxicity in elderly patients with diffuse B-cell non-Hodgkin's lymphoma. J Clin Oncol 2008;26:3159-65.
• 16. Braverman AC, Antin JH, Plappert MT, Cook EF, Lee RT. Cyclophosphamide cardiotoxicity in bone marrow transplantation: a prospective evaluation of new dosing regimens. J Clin Oncol 1991;9:1215-23.
• 17. Morandi P, Ruffini PA, Benvenuto GM, Raimondi R, Fosser V. Cardiac toxicity of high-dose chemotherapy. Bone Marrow Transplant 2005;35:323-34.
• 18. Sarzhevskiy V, Kolesnikova D, Melnichenko V, Vakhromeeva M. Cardiotoxicity of high-dose chemotherapy with autologous hematopoietic stem cells transplantation in patients with malignant lymphomas. What is worse - BEAM or CBV? ESMO Ann Oncol 2014;25:423-9.
• 19. Zver S, Zadnik V, Cernelc P, Kozelj M. Cardiac toxicity of high-dose cyclophosphamide and melphalan in patients with multiple myeloma treated with tandem autologous hematopoietic stem cell transplantation. Int J Hematol 2008;88:227-36.
• 20. Roziakova L, Bojtarova E, Mistrik M, Dubrava J, Gergel J, Lenkova N, et al. Serial measurements of cardiac biomarkers in patients after allogeneic hematopoietic stem cell transplantation. J Exp Clin Cancer Res 2012;31:13.
• 21. Cardinale D, Colombo A, Sandri MT, Lamantia G, Colombo N, Civelli M, et al. Prevention of high-dose chemotherapy-induced cardiotoxicity in high-risk patients by angiotensin-converting enzyme inhibition. Circulation 2006;114:2474-81.
• 22. Kalay N, Basar E, Ozdogru I, Er O, Cetinkaya Y, Dogan A, et al. Protective effects of carvedilol against anthracycline-induced cardiomyopathy. J Am Coll Cardiol 2006;48:2258-62.