Impact of cumulative anthracycline dose, preparative regimen and chronic graft-versus-host disease on pulmonary and cardiac function in children 5 years after allogeneic hematopoietic stem cell transplantation: A prospective evaluation on behalf of the EBMT Pediatric Diseases and Late Effects Working Parties

Centro Trapianti di Midollo Osseo, Clinica Pediatrica e, Ospedale San Gerardo di Monza Università di Milano Bicocca, Milano, Italy.
Bone Marrow Transplantation (Impact Factor: 3.57). 06/2007; 39(11):667-75. DOI: 10.1038/sj.bmt.1705652
Source: PubMed


This prospective study focused on risk factors and clinical outcome of pulmonary and cardiac late effects after allogeneic hematopoietic stem cell transplantation (allo-HSCT). We prospectively evaluated 162 children by pulmonary function tests (PFTs) and cardiac shortening fraction (SF) before allo-HSCT and yearly up to the 5th year of follow-up. The 5-year cumulative incidence of lung and cardiac impairment was 35 (hazard rate=0.03) and 26% (hazard rate=0.06), respectively. Patients presenting abnormal PFTs and SF at last follow-up were 19 and 13%, respectively, with a median Lansky performance status of 90% (70-100). Chronic graft-versus-host disease (c-GVHD) was the major risk factor for reduced lung function in univariate (P=0.02) and multivariate analysis (P=0.02). Total body irradiation (TBI) alone and TBI together with pre-transplant anthracycline administration were significant risk factors for reduced cardiac function in univariate analysis, only (P=0.04 and 0.004, respectively). In conclusion, our prospective study demonstrates an asymptomatic post-allo-HSCT deterioration of pulmonary and cardiac function in some long-term survivors, who had been transplanted in childhood, and thus emphasizes the need for lifelong cardiopulmonary monitoring and the development of new strategies both to reduce pre-transplant cardiotoxic regimens and to treat more efficiently c-GVHD.


Available from: Karsten Nysom, Apr 10, 2014
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    • "In paediatric patients, late cardiac complications after HCT are even rarer (Leung et al, 2007). In a prospective mutlicentre study of the EBMT, cardiac shortening fraction performed by M-mode echocardiogram before and yearly up to 5 years of follow-up was evaluated in 119 children treated with allogeneic HCT (Uderzo et al, 2007). The 5-year cumulative incidence of cardiac impairment was 26%. "
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