Fatal cardiomyopathy developed in two patients receiving cyclophosphamide in preparation for bone marrow transplantation. Both patients had normal EKGs prior to receiving cyclophosphamide in total doses of 168 mg/kg (case 1) and 144 mgkg (case 2) and subsequently developed loss of voltage and ST-T wave changes. One patient (case 1) died of CHF and hypotension while the other patient (case 2) developed tamponade. Prior to this report, the lowest total dose of cyclophosphamide reported to cause fatal cardiomyopathy was 180 mgkg. In contrast to anthracycline congestive cardiomyopathy, the effects of cyclophosphamide appear to have an acute onset and do not appear to be the cumulative result of drug dosing. Postmortem examination in both patients revealed thickened left ventricles with intramyocardial hemorrhage. Cancer 43:2223-2426,1979. YCLOPHOSPHAMIDE (CTX), an alkylating C agent effective against a wide variety of malignancies, has well-described toxic effects on the bone marrow, gastrointestinal tract and bladder.8*9*12 Cardiotoxic effects have recently been recognized with the use of high dose CTX therapy in patients prior to bone marrow transplantation.'' The purpose of this paper is to present two fatal cases of CTX cardiomyopathy seen at Barnes Hospital since implementation of bone marrow transplantation and to review the English literature concerning this toxicity.
CASE
REPORTS
Case 1
In 1975, a 31-year-old male was diagnosed as Stage IIIS+*+A, mixed cellularity Hodgkins disease. After an unknown dose of total nodal radiation therapy and six courses of MOPP, he developed aplastic anemia with a large transfusion requirement. In October 1977, he was admitted to the hospital for evaluation of recent fever and for consideration of bone marrow transplantation.