Evaluation of pretransplant factors predicting cardiac dysfunction following high-dose melphalan conditioning and autologous peripheral blood stem cell transplantation.

Abstract

BACKGROUND:

Cardiac complications following hematopoietic stem cell transplantation (HSCT) are emerging as a significant concern given the increasing utilization of HSCT for a variety of hematologic malignancies.

METHODS:

We utilized an existing database to determine the frequency of cardiac dysfunction (CD), namely a decrease in left ventricular ejection fraction, following conditioning with high-dose melphalan (HDM) and autologous HSCT for multiple myeloma (MM) and systemic amyloidosis (AL). We then performed a case-control study to examine variables associated with increased risk of CD in this population.

RESULTS:

In MM patients undergoing HSCT, the rate of CD was 1.6% (17/1050, 95% CI: [0.9, 2.6]). None of the examined pre-HSCT variables or HDM dose were significantly associated with development of CD in this population. In patients with AL, the rate of CD was 5.6% (24/426, 95% CI: [3.6, 8.3]). On univariate analysis, decision to administer an HDM dose <200 mg/m(2) [odds ratio (OR): 4.59 (1.27-16.57) P = 0.02], pretransplant left ventricular ejection fraction <60% [OR: 17.78 (2.29-138.33) P = 0.006], and documented amyloid involvement of ≥ 3 organs [OR: 4.0 (1.03-15.6) P = 0.046] were associated with the development of CD in the AL population. No other examined peri-transplant factors were associated with development of CD.

CONCLUSION:

To our knowledge, this is the first series to report a significant rate of CD following HDM conditioning and autologous HSCT in patients with AL.

• Authors: Jonathan S Bleeker, Morie A Gertz, Patricia A Pellikka, Dirk R Larson, Francis Buadi, David Dingli, Angela Dispenzieri, Suzanne R Hayman, William Hogan, Shaji Kumar, S Vincent Rajkumar, Martha Q Lacy
• Journal: European journal of haematology (Eur J Haematol) Vol. 89 Issue 3 Pg. 228-35 (Sep 2012) ISSN: 1600-0609 [Electronic] England
• PMID: 22672722 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: © 2012 John Wiley & Sons A/S.

Chemical References

• Antineoplastic Agents, Alkylating
• Melphalan

Topics

• Adult
• Aged
• Antineoplastic Agents, Alkylating (administration & dosage, adverse effects)
• Dose-Response Relationship, Drug
• Female
• Heart (physiopathology)
• Humans
• Male
• Melphalan (administration & dosage, adverse effects)
• Middle Aged
• Retrospective Studies
• Stem Cell Transplantation