Very acute cardiac toxicity during BEAC chemotherapy in non-Hodgkin's lymphoma patients undergoing autologous stem cell transplantation

• Published in: Bone marrow transplantation (Basingstoke) Vol. 36; no. 12; pp. 1077 - 1082
• Main Authors: KUITTINEN, T, HUSSO-SAASTAMOINEN, M, SIPOLA, P, VUOLTEENAHO, O, ALA-KOPSALA, M, NOUSIAINEN, T, JANTUNEN, E, HARTIKAINEN, J
• Format: Journal Article
• Language: English
• Published: Basingstoke Nature Publishing Group 01.12.2005
• Subjects: Adult; Aged; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Anthracycline; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Autografts; Biological and medical sciences; Bone marrow; Bone marrow, stem cells transplantation. Graft versus host reaction; Cancer; Cardiotoxicity; Cardiovascular System - pathology; Care and treatment; Carmustine - therapeutic use; Chemotherapy; Cyclophosphamide - therapeutic use; Cytarabine - therapeutic use; Drug toxicity and drugs side effects treatment; Etoposide - therapeutic use; Female; Health aspects; Heart; Heart - drug effects; Humans; Lymphoma; Lymphoma, Non-Hodgkin - complications; Lymphoma, Non-Hodgkin - therapy; Magnetic Resonance Imaging; Male; Medical sciences; Methods; Middle Aged; Natriuretic Peptides - blood; Non-Hodgkin's lymphoma; Non-Hodgkin's lymphomas; Peptides; Peptides - chemistry; Pharmacology. Drug treatments; Plasma levels; Prognosis; Prospective Studies; Stem cell transplantation; Stem Cell Transplantation - methods; Stem cells; Time Factors; Toxicity; Toxicity: cardiovascular system; Transfusions. Complications. Transfusion reactions. Cell and gene therapy; Transplantation; Transplantation, Autologous; Ventricle; Ventricular Dysfunction, Left - diagnosis; Ventricular Function, Left; Finland; Antineoplastic agent; magnetic resonance imaging; Toxicity; Stem cell; Hematopoietic cell; Cardiovascular disease; Atrial natriuretic peptide; natriuretic peptides; Autograft; Natriuretic hormone; Isomerases; Cancerology; Cytarabine; non-Hodgkin's lymphoma; Heart disease; Lymphoproliferative syndrome; Graft; Complication; Antimitotic; High dose; Human; Heart failure; DNA topoisomerase (ATP-hydrolysing); Drug combination; Hematology; Enzyme; Acute; Carmustine; Enzyme inhibitor; Etoposide; Malignant hemopathy; Non Hodgkin lymphoma; Nuclear magnetic resonance imaging; Podophyllotoxine derivatives; high-dose therapy; Alkylating agent; Oxazaphosphinane derivatives; Chemotherapy; Cyclophosphamide; cardiotoxicity; Treatment; Nitrogen mustard; Medical imagery; Therapeutic protocol
• ISSN: 0268-3369; 1476-5365
• DOI: 10.1038/sj.bmt.1705175

Cardiotoxicity is potentially the most threatening nonhaematological side effect of high-dose CY. We prospectively evaluated the very acute cardiac effects of high-dose CY in 17 adult non-Hodgkin's lymphoma (NHL) patients receiving CY 1500 mg/m2/day as a part of BEAC high-dose therapy (HDT). Magnetic resonance imaging (MRI) and plasma natriuretic peptide (NT-proBNP, NT-proANP) measurements were performed prior to HDT (d-7) and just after completing HDT (d-2). After the high-dose CY left atrial end-systolic area increased from 15.2+/-1.2 to 18.5+/-1.4 cm2 (P=0.001), left ventricular end-diastolic volume from 136.1+/-12.3 to 156.6+/-11.1 cm3 (P=0.04) and left ventricular end-systolic volume from 67.4+/-7.8 to 75.3+/-7.1 cm3 (P=0.018). However, no significant change in left ventricular ejection fraction (LVEF) was observed. At the same time, plasma levels of NT-proBNP increased from 134.9+/-53.3 to 547.1+/-168.4 pmol/l (P=0.003) and NT-proANP from 481.1+/-105.5 to 1056.6+/-193.1 pmol/l (P=0.001), respectively. To conclude, high-dose CY results in very acute cardiac toxicity characterised by enlargement of the heart chambers in NHL patients previously treated with anthracyclines. This toxicity can be detected with increased concentrations of circulating natriuretic peptides but not with LVEF measurement.