Fatal cardiac toxicity in bone marrow transplant patients receiving cytosine arabinoside, cyclophosphamide, and total body irradiation

✍ Scribed by Michael E. Trigg; Jonathon L. Finlay; Marek Bozdech; Enid Gilbert

• Publisher: John Wiley and Sons
• Year: 1987
• Tongue: English
• Weight: 627 KB
• Volume: 59
• Category: Article
• ISSN: 0008-543X
• DOI: 10.1002/1097-0142(19870101)59:1<38::aid-cncr2820590112>3.0.co;2-t

✦ Synopsis

Three patients developed fatal cardiac toxicity from the combination of cytosine arabinoside, cyclophosphamide, and total body irradiation while undergoing preparation for a bone marrow transplant. The pattern of the toxicity was unique for this combination of ablative chemotherapy. All three patients had autopsies demonstrating characteristic myocardial and pericardial toxicity. The cardiotoxic effects of this combination may be averted by lowering the dose of the cyclophosphamide.

Cancer 59:38-42, 1987.

ARDIAC TOXICITY secondary to the ablative C therapy used in bone marrow transplant patients has previously been reported in those undergoing autologous transplantation for non-Hodglun's lymphomas and for those undergoing standard allogeneic transplants receiving high dose cyclophosphamide.'-" The vast majority of these case reports in the literature involve patients who previously had received significant doses of anthracyclines and probably had sustained tissue damage to the myocardium not measurable on routine isotopic, electrocardiographic, or ultrasonographic studies. One study has documented the use of nitrogen mustard to prepare patients for transplantation if pretransplant cardiac dysfunction was d~cumented.~ Unfortunately, in that report, the nitrogen mustard therapy was not as efficient as the cyclophosphamide in terms of preventing relapse following transplantation and was also associated with an increased neurologic toxicity. In our early experience with mismatched bone marrow transplants, it was found that additional immunosuppression in the form of cytosine arabinoside pretransplantation combined with the usual high-dose cyclophosphamide and total body irradiation would permit engraftment of the haploidentical donor marrow when previously this had not been possible.6 In the early stages of that study, the majority of patients accepted for trans-From the Department of Pediatrics, Pathology and Medicine, Uni-