Severe cardiac toxicity in hematological stem cell transplantation: predictive value of reduced left ventricular ejection fraction

Eighty patients receiving hematological stem cell transplantation (HCT) wit h a preparative regimen consisting of total body irradiation (12.5 Gy), cyc lophosphamide (4000 or 4500 mg/m(2)), and thiotepa (400 mg/m(2)) were evalu ated for the development of cardiac toxicity. Patients in whom the pretrans plant cumulative dose of anthracycline was more than or equal to 300mg/m(2) showed a lower left ventricular ejection fraction (EF) before HCT compared to patients with less than 300mg/m(2) (0.61+/-0.09 vs 0.67+/-0.06, P = 0.0 010). Patients who had undergone more than or equal to six courses of chemo therapy showed a decreased EF before HCT compared to those after less than six courses (0.67 +/- 0.05 vs 0.63 +/- 0.09, P = 0.03). Three of seven pati ents (43%) whose pretransplant EF had been less than or equal to 0.55 devel oped severe cardiac toxicity, characterized by congestive heart failure (CH F) compared with none of 83 patients (0%) whose pretransplant EF had been m ore than 0.55 (P = 0.00026). Of the three patients who developed severe car diac toxicity, two were given more than 300mg/m(2) of cumulative anthracycl ine and underwent 23 courses and six courses of chemotherapy, while the oth er patient received only two courses of chemotherapy with a total dose of 1 39 mg/m(2) of anthracycline. These results indicate that an increased cumul ative dose of anthracycline and number of chemotherapy treatments are corre lated with a decrease of the EF and that the EF before HCT is useful for pr edicting the risk of cardiac complications for recipients who have received chemotherapy.