Acute left ventricular failure following melphalan and fludarabine conditioning

Cardiotoxicity has rarely been reported as a complication of melphalan or f ludarabine administration as single agents. Recently, melphalan and fludara bine have been used in combination as non-myeloablative conditioning chemot herapy prior to allogeneic stem cell transplantation. We have observed the development of severe left ventricular failure in three of 21 patients trea ted with this combination. Cardiotoxicity in this context has not previousl y been reported and has implications for the assessment, monitoring and tre atment of patients undergoing pre-transplant conditioning with melphalan an d fludarabine.