Autologous Hemopoietic Stem-Cell Transplantation in Patients with Preexisting Cardiac Abnormalities.

Abstract

INTRODUCTION: High dose chemotherapy and autologous hemopoietic stem cells transplantation (AHSCT) represents an useful treatment for patients undergoing hematological diseases. Relapsed lymphomas, acute leukemias and multiple myeloma achieve a better outcome with a low incidence of complications and mortality related to the procedure. Assessment of pre-transplant organ function (including cardiopulmonary, kidney and liver) is a routine part of eligibility criteria for AHSCT protocols. Left ventricle (LV) function has been considered one of the most important risk factor in predicting complications or mortality related to transplantation, although, previous studies have not confirmed these issues. The purpose of our retrospective study was to investigate differences among clinical outcome, therapeutic requirements and Transplant Related Mortality (TRM) in patients (pts) undergoing AHSCT with and without cardiac pathology.METHODS: We retrospectively reviewed data from 290 pts undergoing AHSCT between September 1991 to June 2006. Routine pretransplant evaluation included ECG and Bidimensional Echocardiography (BE). We compared Group A including pts with any of the following: Impairment of Left Ventricle systolic function (ILVF) (Ejection fraction <50%), Ischaemic cardiac disease (ICD), Dilated myocardiopathy (DM), Valvulopathy (VP), Chronic arrythmia (CA), Wall motion abnormalities (WMA), and Restrictive myocardiopathy (RM); and Group B pts with no cardiac abnormalities. Clinical course, infectious, cardiopulmonary or other complications, hematological recovery time and TRM were reviewed for each enrolled pts. Statistical analysis was performed using chi square tests.RESULTS: Group B (control) included 269 of 290 evaluated pts without cardiac abnormalities and group A included 21 pts with the following criteria: 5 pts: DM, 5 pts: ICD, 6 pts: VP, 2 pts: CA, 2 pts: RM and 1 pts: ILVF. Mean age in Group A was higher than control group (49,1 ±13 vs 36,1 ±16) p<0,001. No differences was found between both groups about: Gender (male 58% vs female 51%), Diagnosis (Group A: Non-Hodgkin's Lymphoma 38,1%, Hodgkin's Disease 14,3%, Acute Leukemia 9,5%, Multiple Myeloma 38,1% vs Group B: Non-Hodgkin's Lymphoma 24,5%, Hodgkin's Disease 26,7%, Acute Leukemia 17,4%, Multiple Myeloma 19,3%), Stem cell source (Group A: Peripheral Blood Stem cells 90,5% vs 72% in group B) or Mean number of administered CD 34 positive cells (4,2 × 106 ±2,5/kg in group A vs 7,066 ±3,4/kg in control group). Comparative Results between Groups are shown in the table:CONCLUSIONS: No significant differences were observed among hospitalization time, infectious episodes, extracardiac toxicities and transplant related mortality. The incidence of cardiac complications was higher but this did not increase the number of TRM. These results prevent us about rigid eligibility criteria that potentially denie patients the benefit of AHSCT.Group AGroup BHospitalization days*23±524±10,3Neutrophil Engrafment (days)*11,3±3,712,05±4,3Days on antibiotics*11±4,111,6±5,5Positive Blood Cultures(%)*23,827,1Platelet engrafment (days)*13,5915,66Packed red cell transfused (n)*4,23,22Platelet transfused (n)*5,95,64Acute Renal dysfunction(%)*9,54Congestive Heart Failure(%)**14,32,8Hepatotoxicity(%)*14,38,3Pulmonary Injury(%)*4,73,8Arrythmias(%)**14,32,9Grade III–IV Mucositis(%)*42,951TRM(%)*4,83,42* p NS **p<0,05