“Large Pericardial Effusions as a Manifestation of Graft Versus Host Disease: a Single Institution Retrospective Study”.

Abstract

Abstract 4659 IntroductionLarge pericardial effusion (LPE) as a manifestation of polyserositis is a known complication of GVHD. Due to its rarity, the incidence and natural history of LPEs are lacking in adult stem cell transplant recipients and current evidence is based on published case reports. MethodsWe retrospectively evaluated the incidence post-transplant LPE development for all adult patients who underwent transplants at our institution from 2005 to 2008. ResultsDuring this period, 858 transplants were performed, 512 autologous and 346 allogeneic (148 related and 198 unrelated). No LPEs were documented in post-autologous transplant patients. One patient developed polyserositis with LPE after allogeneic transplant on imatinib therapy and was excluded from this analysis. Seven patients (2%) who received unrelated transplant developed LPEs a median 229 days (range 42-525 days) post-transplant (Table 1). Only two patients developed large LPEs less than 100 days post-transplant, however in both cases LPEs developed after the second transplant. Six patients (86%) developed biopsy proven GVHD prior to the detection of LPEs; among them 5 (83%) had skin and GI tract involvement and 1 (17%) had GVHD of the liver. Six patients (86%) had concomitant pleural effusions (PEs). No patients had active manifestations of GVHD besides polyserositis at the time of LPE detection. Six patients (86%) required pericardial window (PW) placement with a pericardial biopsy; none had evidence of a malignant or infectious process involving the pericardium. Four patients were alive a median of 172 days (range 20-274 days) post LPE detection and all 4 had PW placed. Out of 4 survived patients, 3 had steroids initiated or increased with a clinical improvement of polyserositis on subsequent follow up in 2 patients and 1 patient had persistent pleural effusions. One patient had a systemic relapse shortly after LPE detection. Three patients died, among them 2 had PW placed and died less than 100 days after LPE detection; the first patient died at day 93 from MRSA pneumonia and the second one died at day 7 from polymicrobial sepsis and multiorgan failure. Both these patients had undergone a second transplant when the LPE occurred. The third patient, who did not receive a PW, died of progressive bronchiolitis obliterans, 542 days after LPE detection, her polyserositis symptoms resolved while on cyclosporine therapy. ConclusionLPE is a rare complication after allogeneic transplant in adults and in our study developed only after unrelated transplant. PW can be safely performed in these patients and polyserositis can be successfully treated with systemic steroids, although patients might continue having polyserositis despite aggressive immunosupression. AbbreviationsMUD= matched unrelated donor, S=skin, L=liver, GI=gastrointestinal tract, Bu= busulfan, Flu= fludarabine, TBI= total body irradiation, CVB= cyclophosphamide, etoposide and BCNUTable 1#AgeDiag-nosisDonorHLA matchCyto-reductionGVHDPost-transplant day LPE detectedConco-mitant PEPeri-cardial windowPericardial biopsyImmunosuppression at the LPE detection136ALLMUD10/10VP16-TBIS,GI (not active)217YesYesInflammationTacrolimus241AMLMUD10/10Bu-FluS (not active)51NoYesInflammationTacrolimus358AMLMUD10/10Bu-FluS,GI,L (not active)290YesYesInflammationTacrolimus+methylprednisolone464MDSMUD10/10Bu-Flu-TBINot present42YesYesNormalTacrolimus541AMLMUD10/10Bu-FluS,GI (not active)525YesYesInflammationTacrolimus+rituximab+methylprednisolone647NHLMUD9/10Bu-Flu-TBIGI (not active)230YesYesInflammationTacrolimus747NHLMUD8/10CVBS,GI (not active)250YesNoNot performedCyclosporine Disclosures:Abidi:Merck Pharmaceuticals: Research Funding. Lum:Transtarget Corporation: Founder.