Cardiomyopathy Following Stem Cell Transplantation

Cardiac complications in patients who have undergone allogeneic hematopoietic stem cell transplantation (HSCT) have been well documented. Most commonly patients present with congestive heart failure and/or pericarditis after receiving high-dose cyclophosphamide, total body irradiation (TBI) or other intensive conditioning / preparative regimens prior to the allogeneic transplant. The majority of the data in the medical literature suggests that the rate of serious cardiac events appears to be relatively low at approximately 5% or less. Recently, there appears to have been a cluster of patient cases (approximately 15) of significant cardiomyopathy in patients who have received an allogeneic HSCT at the NIH Clinical Center over the past year. These cases have been consulted on by the Cardiology consult service and have included both NCI and NHLBI protocol patients. This cluster of cases has prompted concern that the incidence of cardiac toxicity recently seen at the NIH Clinical Center is not consistent with the reported incidence of significant cardiac toxicity in the medical literature.

The proposed retrospective chart review is intended to further define the incidence of cardiac toxicity, primarily focusing on cardiomyopathy. The project is an initial step to consolidate the data from both the NCI and NHLBI transplant programs and clarify the documented cardiac toxicities, the incidence, and the demographics of the patient populations. We also plan to document the presence or absence of a variety of known and suspected risk factors for cardiotoxicity. This analysis will only be preliminary but will potentially lead to more formal prospective studies on cardiotoxicity related to allogeneic HSCT.