Myocarditis with Advanced Atrioventricular Block after Allogeneic Stem Cell Transplantation: A Case Report and Literature Review
A 51-year-old woman with Philadelphia chromosome-positive acute lymphoblastic leukemia underwent a second cord blood transplantation followed by maintenance therapy with interferon-α. After 33 months, she developed cardiogenic shock caused by advanced atrioventricular block. Laboratory tests reveale...
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| Published in | Internal Medicine Vol. 59; no. 1; pp. 113 - 118 |
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01.01.2020
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| Abstract | A 51-year-old woman with Philadelphia chromosome-positive acute lymphoblastic leukemia underwent a second cord blood transplantation followed by maintenance therapy with interferon-α. After 33 months, she developed cardiogenic shock caused by advanced atrioventricular block. Laboratory tests revealed increased myocardium enzymes, and ultrasonic cardiography demonstrated mild thickening of the left ventricular wall. She was diagnosed with myocarditis and successfully treated using prednisolone. Myocarditis after allogeneic stem cell transplantation is a rare but potentially fatal complication. However, it is important for physicians to be aware of this complication because all of the symptoms may be reversed with immunosuppressive treatment. |
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| AbstractList | A 51-year-old woman with Philadelphia chromosome-positive acute lymphoblastic leukemia underwent a second cord blood transplantation followed by maintenance therapy with interferon-α. After 33 months, she developed cardiogenic shock caused by advanced atrioventricular block. Laboratory tests revealed increased myocardium enzymes, and ultrasonic cardiography demonstrated mild thickening of the left ventricular wall. She was diagnosed with myocarditis and successfully treated using prednisolone. Myocarditis after allogeneic stem cell transplantation is a rare but potentially fatal complication. However, it is important for physicians to be aware of this complication because all of the symptoms may be reversed with immunosuppressive treatment. A 51-year-old woman with Philadelphia chromosome-positive acute lymphoblastic leukemia underwent a second cord blood transplantation followed by maintenance therapy with interferon-α. After 33 months, she developed cardiogenic shock caused by advanced atrioventricular block. Laboratory tests revealed increased myocardium enzymes, and ultrasonic cardiography demonstrated mild thickening of the left ventricular wall. She was diagnosed with myocarditis and successfully treated using prednisolone. Myocarditis after allogeneic stem cell transplantation is a rare but potentially fatal complication. However, it is important for physicians to be aware of this complication because all of the symptoms may be reversed with immunosuppressive treatment.A 51-year-old woman with Philadelphia chromosome-positive acute lymphoblastic leukemia underwent a second cord blood transplantation followed by maintenance therapy with interferon-α. After 33 months, she developed cardiogenic shock caused by advanced atrioventricular block. Laboratory tests revealed increased myocardium enzymes, and ultrasonic cardiography demonstrated mild thickening of the left ventricular wall. She was diagnosed with myocarditis and successfully treated using prednisolone. Myocarditis after allogeneic stem cell transplantation is a rare but potentially fatal complication. However, it is important for physicians to be aware of this complication because all of the symptoms may be reversed with immunosuppressive treatment. |
| Author | Uematsu, Nozomu Ueki, Toshimitsu Kitahara, Mari Shimizu, Kunihiko Hiroshima, Yuki Shishido, Tsutomu Kobayashi, Hikaru Kazumoto, Hiroko Sato, Keijiro Sumi, Masahiko Kirihara, Takehiko |
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| Cites_doi | 10.1016/j.jacc.2011.09.074 10.1016/j.bbmt.2005.07.002 10.1152/ajpheart.00154.2007 10.1038/sj.bmt.1701038 10.11406/rinketsu.56.485 10.1002/14651858.CD004471.pub3 10.1038/sj.bmt.1705869 10.1161/CIRCRESAHA.115.306573 10.1093/eurheartj/ehq493 10.1080/10428194.2016.1266623 10.1007/s12185-009-0332-3 10.1038/sj.bmt.1702744 10.1038/bmt.2017.114 10.1007/s00277-006-0192-3 10.1182/blood-2009-12-261586 10.1200/JCO.1995.13.9.2401 |
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| Keywords | allogeneic stem cell transplantation atrioventricular block myocarditis graft-versus-host disease |
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| Notes | ObjectType-Case Study-2 SourceType-Scholarly Journals-1 content type line 14 ObjectType-Report-1 ObjectType-Review-5 ObjectType-Feature-4 content type line 23 ObjectType-Article-3 Correspondence to Dr. Masahiko Sumi, sumin@nagano-med.jrc.or.jp |
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| References | 19. Chen HS, Wang W, Wu SN, Liu JP. Corticosteroids for viral myocarditis. Cochrane Database Syst Rev 18: CD004471, 2013. 2. Kindermann I, Barth C, Mahfoud F, et al. Update on myocarditis. J Am Coll Cardiol 59: 779-792, 2012. 8. Bhattacharya S, Paneesha S, Chaganti S, et al. "Viral" myocarditis in a patient following allogenic stem cell transplant: diagnostic dilemma and management considerations. J Clin Virol 45: 262-264, 2009. 11. Nakaseko C, Sakaida E, Ohwada C, et al. Acute fulminant myocarditis after allogeneic peripheral blood stem cell transplantation with reduced-intensity conditioning for acute myelogenous leukemia. Ann Hematol 86: 67-69, 2007. 18. Sacchi S, Kantarjian H, O'Brien S, et al. Immune-mediated and unusual complications during interferon alfa therapy in chronic myelogenous leukemia. J Clin Oncol 13: 2401-2407, 1995. 4. Cereda M, Trocino G, Pogliani EM, Schiavina R. A case of cardiac localization of graft-versus-host disease after allogenic bone marrow transplantation. Ital Heart J 4: 60-63, 2003. 12. Mahfoud F, Gärtner B, Kindermann M, et al. Virus serology in patients with suspected myocarditis: utility or futility? Eur Heart J 32: 897-903, 2011. 16. Yabe M, Ishiguro H, Yasuda Y, et al. Fatal giant cell myocarditis after allogeneic bone marrow transplantation. Bone Marrow Transplant 41: 93-94, 2008. 15. Rackley C, Schultz KR, Goldman FD, et al. Cardiac manifestations of graft-versus-host disease. Biol Blood Marrow Transplant 11: 773-780, 2005. 1. Fung G, Luo H, Qiu Y, Yang D, McManus B. Myocarditis. Circ Res 118: 496-514, 2016. 9. Sumi M, Sato K, Kaiume H, et al. Second cord blood transplantation and interferon-α maintenance therapy for relapsed Ph+ acute lymphoblastic leukemia with the T315I mutation. Leuk Lymphoma 58: 2005-2007, 2017. 10. Ravandi F, O'Brien S, Thomas D, et al. First report of phase 2 study of dasatinib with hyper-CVAD for the frontline treatment of patients with Philadelphia chromosome-positive (Ph+) acute lymphoblastic leukemia. Blood 116: 2070-2077, 2010. 5. Ahn JS, Cho SH, Kim YK, et al. Polymyositis and myocarditis after donor lymphocyte infusion. Int J Hematol 90: 113-116, 2009. 14. Platzbecker U, Klingel K, Thiede C, et al. Acute heart failure after allogeneic blood stem cell transplantation due to massive myocardial infiltration by cytotoxic T cells of donor origin. Bone Marrow Transplant 27: 107-109, 2001. 17. Wang YX, da Cunha V, Vincelette J, et al. Antiviral and myocyte protective effects of murine interferon-β and -α2 in coxsackievirus B3-induced myocarditis and epicarditis in Balb/c mice. Am J Physiol Heart Circ Physiol 293: H69-H76, 2007. 13. Henry K. Some ultrastructural aspects of bone marrow transplantation: hitherto unrecognized manifestations of GVHR involving heart, and polyoma virus infection in two children. Pathol Biol (Paris) 26: 55-65, 1978. 20. Frustaci A, Russo MA, Chimenti C. Randomized study on the efficacy of immunosuppressive therapy in patients with virus-negative inflammatory cardiomyopathy: the TIMIC study. Eur Heart J 30: 1995-2002, 2009. 3. Gilman AL, Kooy NW, Atkins DL, et al. Complete heart block in association with graft-versus-host disease. Bone Marrow Transplant 21: 85-88, 1998. 6. Morimoto Y, Oka S, Tashima M, Hamahata K, Nohgawa M. Chronic GVHD complicated with polymyositis and cardiomyopathy after myeloablative hematopoietic stem cell transplantation. Rinsho Ketsueki 56: 485-490, 2015 (in Japanese, Abstract in English). 7. Zinter MS, Barrows BD, Ursell PC, et al. Extracorporeal life support survival in a pediatric hematopoietic cellular transplant recipient with presumed GvHD-related fulminant myocarditis. Bone Marrow Transplant 52: 1330-1333, 2017. 11 12 13 14 15 16 17 18 19 1 2 3 4 5 6 7 8 9 20 10 |
| References_xml | – reference: 3. Gilman AL, Kooy NW, Atkins DL, et al. Complete heart block in association with graft-versus-host disease. Bone Marrow Transplant 21: 85-88, 1998. – reference: 11. Nakaseko C, Sakaida E, Ohwada C, et al. Acute fulminant myocarditis after allogeneic peripheral blood stem cell transplantation with reduced-intensity conditioning for acute myelogenous leukemia. Ann Hematol 86: 67-69, 2007. – reference: 1. Fung G, Luo H, Qiu Y, Yang D, McManus B. Myocarditis. Circ Res 118: 496-514, 2016. – reference: 17. Wang YX, da Cunha V, Vincelette J, et al. Antiviral and myocyte protective effects of murine interferon-β and -α2 in coxsackievirus B3-induced myocarditis and epicarditis in Balb/c mice. Am J Physiol Heart Circ Physiol 293: H69-H76, 2007. – reference: 19. Chen HS, Wang W, Wu SN, Liu JP. Corticosteroids for viral myocarditis. Cochrane Database Syst Rev 18: CD004471, 2013. – reference: 9. Sumi M, Sato K, Kaiume H, et al. Second cord blood transplantation and interferon-α maintenance therapy for relapsed Ph+ acute lymphoblastic leukemia with the T315I mutation. Leuk Lymphoma 58: 2005-2007, 2017. – reference: 14. Platzbecker U, Klingel K, Thiede C, et al. Acute heart failure after allogeneic blood stem cell transplantation due to massive myocardial infiltration by cytotoxic T cells of donor origin. Bone Marrow Transplant 27: 107-109, 2001. – reference: 6. Morimoto Y, Oka S, Tashima M, Hamahata K, Nohgawa M. Chronic GVHD complicated with polymyositis and cardiomyopathy after myeloablative hematopoietic stem cell transplantation. Rinsho Ketsueki 56: 485-490, 2015 (in Japanese, Abstract in English). – reference: 20. Frustaci A, Russo MA, Chimenti C. Randomized study on the efficacy of immunosuppressive therapy in patients with virus-negative inflammatory cardiomyopathy: the TIMIC study. Eur Heart J 30: 1995-2002, 2009. – reference: 4. Cereda M, Trocino G, Pogliani EM, Schiavina R. A case of cardiac localization of graft-versus-host disease after allogenic bone marrow transplantation. Ital Heart J 4: 60-63, 2003. – reference: 2. Kindermann I, Barth C, Mahfoud F, et al. Update on myocarditis. J Am Coll Cardiol 59: 779-792, 2012. – reference: 12. Mahfoud F, Gärtner B, Kindermann M, et al. Virus serology in patients with suspected myocarditis: utility or futility? Eur Heart J 32: 897-903, 2011. – reference: 13. Henry K. Some ultrastructural aspects of bone marrow transplantation: hitherto unrecognized manifestations of GVHR involving heart, and polyoma virus infection in two children. Pathol Biol (Paris) 26: 55-65, 1978. – reference: 18. Sacchi S, Kantarjian H, O'Brien S, et al. Immune-mediated and unusual complications during interferon alfa therapy in chronic myelogenous leukemia. J Clin Oncol 13: 2401-2407, 1995. – reference: 5. Ahn JS, Cho SH, Kim YK, et al. Polymyositis and myocarditis after donor lymphocyte infusion. Int J Hematol 90: 113-116, 2009. – reference: 8. Bhattacharya S, Paneesha S, Chaganti S, et al. "Viral" myocarditis in a patient following allogenic stem cell transplant: diagnostic dilemma and management considerations. J Clin Virol 45: 262-264, 2009. – reference: 10. Ravandi F, O'Brien S, Thomas D, et al. First report of phase 2 study of dasatinib with hyper-CVAD for the frontline treatment of patients with Philadelphia chromosome-positive (Ph+) acute lymphoblastic leukemia. Blood 116: 2070-2077, 2010. – reference: 15. Rackley C, Schultz KR, Goldman FD, et al. Cardiac manifestations of graft-versus-host disease. Biol Blood Marrow Transplant 11: 773-780, 2005. – reference: 7. Zinter MS, Barrows BD, Ursell PC, et al. Extracorporeal life support survival in a pediatric hematopoietic cellular transplant recipient with presumed GvHD-related fulminant myocarditis. Bone Marrow Transplant 52: 1330-1333, 2017. – reference: 16. Yabe M, Ishiguro H, Yasuda Y, et al. Fatal giant cell myocarditis after allogeneic bone marrow transplantation. Bone Marrow Transplant 41: 93-94, 2008. – ident: 2 doi: 10.1016/j.jacc.2011.09.074 – ident: 15 doi: 10.1016/j.bbmt.2005.07.002 – ident: 17 doi: 10.1152/ajpheart.00154.2007 – ident: 3 doi: 10.1038/sj.bmt.1701038 – ident: 4 – ident: 6 doi: 10.11406/rinketsu.56.485 – ident: 19 doi: 10.1002/14651858.CD004471.pub3 – ident: 16 doi: 10.1038/sj.bmt.1705869 – ident: 1 doi: 10.1161/CIRCRESAHA.115.306573 – ident: 12 doi: 10.1093/eurheartj/ehq493 – ident: 13 – ident: 9 doi: 10.1080/10428194.2016.1266623 – ident: 5 doi: 10.1007/s12185-009-0332-3 – ident: 14 doi: 10.1038/sj.bmt.1702744 – ident: 7 doi: 10.1038/bmt.2017.114 – ident: 11 doi: 10.1007/s00277-006-0192-3 – ident: 10 doi: 10.1182/blood-2009-12-261586 – ident: 8 – ident: 20 – ident: 18 doi: 10.1200/JCO.1995.13.9.2401 |
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| SubjectTerms | Acute lymphoblastic leukemia allogeneic stem cell transplantation atrioventricular block Atrioventricular Block - diagnosis Atrioventricular Block - drug therapy Atrioventricular Block - etiology Case Report Cord blood Cord Blood Stem Cell Transplantation Echocardiography Electrocardiography Female Glucocorticoids - therapeutic use Graft vs Host Disease - complications Graft vs Host Disease - diagnosis Graft vs Host Disease - drug therapy graft-versus-host disease Heart Heart diseases Humans Internal medicine Literature reviews Lymphatic leukemia Middle Aged Myocarditis Myocarditis - diagnosis Myocarditis - drug therapy Myocarditis - etiology Myocardium Philadelphia chromosome Precursor Cell Lymphoblastic Leukemia-Lymphoma - therapy Prednisolone Prednisolone - therapeutic use Shock, Cardiogenic - diagnosis Shock, Cardiogenic - etiology Stem cell transplantation Stem cells Ventricle α-Interferon |
| Title | Myocarditis with Advanced Atrioventricular Block after Allogeneic Stem Cell Transplantation: A Case Report and Literature Review |
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