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Post-Transplant Complications

Assessment of cardiotoxicity during haemopoietic stem cell transplantation with plasma brain natriuretic peptide

Bone Marrow Transplantation volume 26, pages 309–313 (2000)Cite this article

Abstract

cardiac failure is a known complication of haemopoietic stem cell transplantation (hsct) and is often difficult to diagnose as patients may have multiple medical problems. since brain natriuretic peptide (bnp) is largely a hormone of cardiac ventricular origin and is released early in the course of ventricular dysfunction, we have examined the value of serial plasma bnp levels for detecting cardiac failure in patients undergoing cytotoxic conditioning for hsct. fifteen patients undergoing hsct were evaluated (10 undergoing autologous hsct; five undergoing allogeneic hsct). bnp was measured by radioimmunoassay prior to therapy and weekly for 5 weeks. seven patients had a significant rise in bnp level (above a previously established threshold of 43 pmol/l associated with cardiac failure), occurring 1–4 weeks post commencement of conditioning. in three of these patients, cardiac failure was subsequently diagnosed clinically 3, 9 and 23 days after a bnp level of 43 pmol/l had been detected. these three patients had the highest peak bnp levels for the group and in each case elevation in bnp level occurred for a period exceeding 1 week. although numbers were relatively small, a bnp >43 pmol/l was significantly associated with the inclusion of high-dose cyclophosphamide in the preparative regimen (P = 0.02). BNP levels showed no relationship to febrile episodes. In conclusion, these results show that plasma BNP may be used as a marker for early detection of cardiac dysfunction in patients undergoing HSCT, particularly if levels are increased for periods exceeding 1 week. Measurement of BNP during HSCT may be helpful in patients at risk of cardiac failure, in complex clinical situations and in monitoring the cardiotoxicity of preparative regimens. Bone Marrow Transplantation (2000) 26, 309–313.

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References

  1. Petersen FB, Bearman SI . Preparative regimens and their toxicity. In: Forman SJ, Blume KG, Thomas ED (eds) Bone Marrow Transplantation Blackwell Scientific Publications: Boston 1994 pp82–83

    Google Scholar 

  2. Feneley MP, Lim CA . Cardiac complications. In: Atkinson K (ed) Clinical Bone Marrow and Stem Cell Transplantation Cambridge University Press: Cambridge 2000 pp952–957

    Google Scholar 

  3. Cazin B, Gorin NC, Laporte JP et al. Cardiac complications after bone marrow transplantation. A report on 63 consecutive transplantations Cancer 1986 57: 2061–2069

    Article  CAS  Google Scholar 

  4. Gottdiener JS, Appelbaum FR, Ferrans VJ et al. Cardiotoxicity associated with high dose cyclophosphamide therapy Arch Intern Med 1981 141: 758–763

    Article  CAS  Google Scholar 

  5. Goldberg M, Antin JH, Guinin EC et al. Cyclophosphamide cardiotoxicity: an analysis of dosing as a risk factor Blood 1986 68: 1114–1118

    CAS  PubMed  Google Scholar 

  6. Parillo JE . Cardiovascular dysfunction in septic shock: new insights into a deadly disease Int J Cardiol 1985 7: 314–321

    Article  Google Scholar 

  7. Kupari M, Volin L, Suokas A et al. Cardiac involvement in bone marrow transplantation: electrocardiographic changes, arrhythmia, heart failure and autopsy findings Bone Marrow Transplant 1990 5: 91–98

    CAS  PubMed  Google Scholar 

  8. Sudoh T, Kangawa K, Minamino N et al. A new natriuretic peptide in porcine brain Nature 1988 332: 78–81

    Article  CAS  Google Scholar 

  9. Mukoyama M, Nakao K, Hosoda K et al. Brain natriuretic peptide as a novel cardiac hormone in humans J Clin Invest 1991 87: 1402–1412

    Article  CAS  Google Scholar 

  10. Lang RE, Tholken H, Ganten D et al. Atrial natriuretic factor – a circulating hormone stimulated by volume loading Nature 1985 314: 264–267

    Article  CAS  Google Scholar 

  11. Yasue H, Yoshimura M, Sumida H et al. Localisation and mechanism of secretion of B-type natriuretic peptide in normal subjects and patients with heart failure Circulation 1994 90: 195–200

    Article  CAS  Google Scholar 

  12. Choy AJ, Darber D, Lang C et al. Detection of left ventricular dysfunction after acute myocardial infarction: comparison of clinical, echocardiographic, and neurohormonal methods Br Heart J 1994 72: 16–22

    Article  CAS  Google Scholar 

  13. Davidson NC, Naas AA, Hanson JK et al. Comparison ofatrial natriuretic peptide, B-type natriuretic peptide, and N-terminal proatrial natriuretic peptide as indicators of leftventricular systolic dysfunction Am J Cardiol 1996 77: 828–831

    Article  CAS  Google Scholar 

  14. Davis M, Espiner E, Richards G et al. Plasma BNP in assessment of acute dysnoea Lancet 1994 343: 440–443

    Article  CAS  Google Scholar 

  15. Cowie MR, Struthers AD, Wood DA et al. Value of natriuretic peptides in the assessment of patients with possible new heart failure in primary care Lancet 1997 350: 1347–1351

    Google Scholar 

  16. Blume K, Forman S, O'Donnell MR et al. Total body irradiation and high dose etoposide: a new preparatory regimen for bone marrow transplant in patients with advanced hematologic malignancies Blood 1987 69: 1015–1020

    CAS  PubMed  Google Scholar 

  17. Powles R, Milliken S, Helenglass G et al. The use of melphalan in conjunction with total body irradiation as treatment for acute leukaemia Transplant Proc 1989 21: 2955–2957

    CAS  PubMed  Google Scholar 

  18. Linch DC, Winfield D, Goldstone AH et al. Dose intensification with autologous bone-marrow transplantation in relapsed and resistent Hodgkin's disease: results of a BNLI randomised trial Lancet 1993 341: 1051–1054

    Article  CAS  Google Scholar 

  19. Jagannath S, Dicke KA, Armitage JO et al. High-dose cyclophosphamide, carmustine, and etoposide and autologous bone marrow transplantation for patients with advanced Hodgkin's disease Ann Intern Med 1986 104: 163–168

    Article  CAS  Google Scholar 

  20. Storb R, Deeg HJ, Whitehead J et al. Methotrexate and cyclosporine compared with cyclosporine alone for prophylaxis of acute graft-versus-host disease after marrow transplant for leukemia New Engl J Med 1986 314: 729–735

    Article  CAS  Google Scholar 

  21. Storb R, Deeg HJ, Pepe M et al. Methotrexate and cyclosporine versus cyclosporine alone for prophylaxis of graft-versus-host disease in patients given HLA-identical marrow grafts for leukemia Blood 1989 73: 1729–1734

    CAS  PubMed  Google Scholar 

  22. Sullivan K . Graft-versus-host disease. In: Forman SJ, Blume KG, Thomas ED Bone Marrow Transplantation Blackwell Scientific Publications: Boston 1994 pp339–362

    Google Scholar 

  23. Yandle TG, Richards AM, Gilbert A et al. Assay of brain natriuretic peptide (BNP) in human plasma: evidence for high molecular weight BNP as a major plasma component in heart failure J Clin Endocrinol Metab 1993 76: 832–838

    CAS  PubMed  Google Scholar 

  24. Fleischer D, Espiner EA, Yandle TG et al. Rapid assay of plasma brain natriuretic peptide in the assessment of acute dyspnoea NZ Med J 1996 100: 71–74

    Google Scholar 

  25. Richards AM, Crozier IG, Yandle TG et al. Brain natriuretic factor: regional plasma concentrations and correlations with haematodynamic state in cardiac disease Br Heart J 1993 69: 414–417

    Article  CAS  Google Scholar 

  26. Hunt PJ, Richards AM, Nicholls MG et al. Immunoreactive amino-terminal pro-brain natriuretic peptide (NT-proBNP): a new marker of cardiac disease Clin Endocrinol 1997 47: 287–296

    Article  CAS  Google Scholar 

  27. Richards AM, Nicholls MG, Yandle TG et al. Plasma N-terminal pro-brain natriuretic and adrenomedulin. New neurohormonal predictors of left ventricular function and prognosis after myocardial infarction Circulation 1998 97: 1921–1929

    Article  CAS  Google Scholar 

  28. Haupt MT, Rackow ED . Adverse effects of febrile state on cardiac performance Am Heart J 1983 105: 763–768

    Article  CAS  Google Scholar 

  29. Richards AM, Nicholls MG, Yandle TG et al. Neuroendocrine prediction of left ventricular function and heart failure after acute myocardial infarction Heart 1999 81: 114–120

    Article  CAS  Google Scholar 

  30. Kupari M, Volin L, Suokas A et al. Cardiac involvement in bone marrow transplantation: serial changes in left ventricular size, mass and performance J Intern Med 1990 227: 259–266

    Article  CAS  Google Scholar 

  31. Gardner SF, Lazarus HM, Bednarczyk EM et al. High-dose cyclophosphamide-induced myocardial damage during BMT: assessment by positron emission tomography Bone Marrow Transplant 1993 12: 139–144

    CAS  PubMed  Google Scholar 

  32. Buja LM, Ferrans VJ, Graw RG . Cardiac pathologic findings in patients treated with bone marrow transplantation Hum Pathol 1976 7: 17–45

    Article  CAS  Google Scholar 

  33. Bauch M, Ester A, Kimura B et al. Atrial natriuretic peptide as a market for doxorubicin-induced cardiotoxic effects Cancer 1992 69: 1492–1497

    Article  CAS  Google Scholar 

  34. Aisenburg AC . Problems in Hodgkin's disease management Blood 1999 93: 761–779

    Google Scholar 

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Acknowledgements

We would like to acknowledge the SIBMTU team for their care of these patients, Dr Tim Yandle, Steve Fisher and Sarah Raudsepp for BNP assay, and Mr Ian Nivison-Smith, Australian Bone Marrow Transplant Recipient Registry, for statistical advice. This study was supported in part by grants from the New Zealand Health Research Council and the National Heart Foundation of New Zealand.

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Authors and Affiliations

  1. South Island Bone Marrow Transplant Unit, Christchurch Hospital, Christchurch, New Zealand

    JA Snowden, GR Hill, S Carnoutsos, RL Spearing & DNJ Hart

  2. Department of Endocrinology, Christchurch Hospital, Christchurch, New Zealand

    P Hunt & E Espiner

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Snowden, J., Hill, G., Hunt, P. et al. Assessment of cardiotoxicity during haemopoietic stem cell transplantation with plasma brain natriuretic peptide. Bone Marrow Transplant 26, 309–313 (2000). https://doi.org/10.1038/sj.bmt.1702507

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