Myocardial function after autologous bone marrow transplantation in children: a prospective long‐term study

Abstract

Early cardiac complications after autologous bone marrow transplantation (ABMT) were recorded for 49 children with haematological malignancies. There was no procedure‐related mortality and only two cases of early post‐transplant cardiac complications of clinical relevance, both of which were reversible. For 35 long‐time survivors (median follow‐up 7y) serial evaluations before and after ABMT included ECG, chest radiography, echocardiography and equilibrium radionuclide ventriculography (RVG). One patient had frequent supraventricular ectopic beats after ABMT, a finding not previously noted. The mean left ventricular diastolic diameter (LVDD) was 104% of expected before ABMT (95% confidence interval 99–110). During the first year post‐transplant LVDD was about 110% of expected, but thereafter normalization occurred. The mean shortening fraction before ABMT was 31% (CI 29–34), compared with the mean value of 34% for healthy children in our laboratory, and it ranged between 29% and 33% during the follow‐up period. Mean left ventricular ejection fraction determined by RVG was 65% (CI 61–69) and mean right ventricular ejection fraction was 46% (CI 43–49) before ABMT, and they did not change during follow‐up. It is encouraging that these heavily pre‐treated children could be autografted without serious cardiac complications or deterioration in myocardial performance in a 5–10‐y prospect, but longer follow‐up is needed for a final evaluation.