Serial measurements of cardiac biomarkers in patients after allogeneic hematopoietic stem cell transplantation.
BACKGROUND
Previous therapy with anthracyclines (ANT) and conditioning regimen followed by hematopoietic stem cell transplantation (HSCT) represents a high risk for development of cardiotoxicity. The aim of this study was to assess subclinical myocardial damage after HSCT using echocardiography and cardiac biomarkers--high sensitive cardiac troponin T (hs-cTnT) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) and to identify patients at risk of developing clinical cardiotoxicity.


METHODS
Thirty-seven patients who were treated with allogeneic HSCT for hematologic diseases at median age of 28 years at time of HSCT were studied. Conditioning regimen included either chemotherapy without total body irradiation (TBI) or combination of chemotherapy with TBI. Twenty-nine (78.3%) patients were pretreated with ANT therapy. Cardiac biomarkers were serially measured before conditioning regimen and at days 1, 14 and 30 after HSCT. Cardiac systolic and diastolic functions were assessed before conditioning regimen and 1 month after HSCT by echocardiography.


RESULTS
The changes in plasma NT-proBNP and hs-cTnT levels during the 30 days following the HSCT were statistically significant (P < 0.01 v.s. P < 0.01). Persistent elevations of NT-proBNP and hs-cTnT simultaneously for a period exceeding 14 days after HSCT were found in 29.7% patients. Serum concentrations of cardiomarkers were significantly elevated in ANT group compared to non-ANT group. These observations were underscored by the echocardiographic studies which did reveal significant changes in systolic and diastolic parameters. Five of 37 (13.5%) patients developed clinical manifestation of cardiotoxicity.


CONCLUSIONS
Elevations in both cardiac biomarkers were found before clinical signs of cardiotoxicity developed. Persistent elevations in NT-pro-BNP and hs-cTnT concentrations simultaneously for a period exceeding 14 days might be used for identification of patients at risk of developing cardiotoxicity and requiring further cardiological follow up.
Institute of Pathological Physiology, School of Medicine, Comenius University, Bratislava, Slovakia.
Lubica
L
Roziakova
Eva
E
Bojtarova
Martin
M
Mistrik
Juraj
J
Dubrava
Jozef
J
Gergel
Nadezda
N
Lenkova
Beata
B
Mladosievicova
D000328:Adult; D018943:Anthracyclines / Q000009:adverse effects* / Q000627:therapeutic use; D001521:Behavior Therapy / Q000379:methods; D015415:Biomarkers / Q000097:blood*; D005260:Female; D005500:Follow-Up Studies; D006402:Hematologic Diseases / Q000628:therapy; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D008297:Male; D009206:Myocardium / Q000378:metabolism / Q000473:pathology; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D014184:Transplantation, Homologous; D020107:Troponin T / Q000097:blood*
D018943:Anthracyclines; D015415:Biomarkers; D010446:Peptide Fragments; D020107:Troponin T; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain