Evaluation of Cardiac Parameters in Bone Marrow Transplant Patients: Effect of Pulmonary Artery Pressure on Survival

Ali Caner Özdöver,Melya Pelin Kırık,Mustafa Pehlivan,İlknur Gündeş,Murat Sucu,Handan Haydaroğlu Şahin

doi:10.4274/tjh.galenos.2018.2018.0015

Abstract

Objective:Hematopoietic stem cell transplantation (HSCT) is a choice of treatment for malignant and non-malignant diseases. After HSCT, some complications may develop in patients. Cardiac complications are particularly important. The aim of this study was to investigate whether systolic pulmonary artery pressure (PAP) is a marker for overall survival (OS) in HSCT patients.Materials and Methods:In our study, 428 HSCT patients were evaluated. Ejection fraction (EF) and PAP values were investigated during symptom-oriented echocardiography in the pre-HSCT and post-HSCT periods.Results:Pre-HSCT EF values were similar between the groups. In patients with autologous HSCT (auto-HSCT) (PAP >25 mmHg), it was found that the 5-year mortality rate was 48.6%, while in the other group (PAP <25 mmHg) the 5-year mortality was 25.5%. There was a significant association between 5-year mortality rate and PAP level (p<0.046) in the auto-HSCT group. OS was 38% in the pre-auto-HSCT period with PAP values of >25 mmHg, while OS was 61% in the pre-auto-HSCT period with PAP values of <25 mmHg (p<0.001). We determined that there was a statistically significant difference between OS and PAP levels in patients with auto-HSCT. Five-year mortality rate and OS were not significantly different in patients undergoing allogeneic HSCT (allo-HSCT) (p>0.05).Conclusion:Our results suggest that pre-HSCT PAP value is an important risk factor for mortality and OS in patients undergoing auto-HSCT.

Highlights

Hematopoietic stem cell transplantation (HSCT) is used in the treatment of life-threatening malignant and non-malignant diseases
In patients with autologous HSCT (PAP >25 mmHg), it was found that the 5-year mortality rate was 48.6%, while in the other group (PAP
There was a significant association between 5-year mortality rate and pulmonary artery pressure (PAP) level (p

Summary

Introduction

Hematopoietic stem cell transplantation (HSCT) is used in the treatment of life-threatening malignant and non-malignant diseases. Allogeneic HSCT (allo-HSCT) can provide an advantage for overall survival (OS) in 15%-20% of patients with acute leukemia after induction therapy and this rate may increase to 35% when HSCT is applied during the first relapse and second remission [1]. Autologous HSCT (auto-HSCT) is a good choice of treatment for multiple myeloma; it can be applied in first- and second-line treatment and can be used in patients with lymphoma as an effective treatment [1]. Short- and long-term complications can develop after HSCT. These include nausea, vomiting, pneumonia, thyroiditis, and cardiovascular side effects [2]. Cardiac complications such as pericarditis, arrhythmia, pulmonary edema, heart failure, and sudden cardiac death developing within the first 100 days of HSCT are considered as acute cardiotoxicity. Studies have shown that post-transplant acute cardiac complications have 1.2% mortality and morbidity ranging from 5% to 43% [3]

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