Otolog hematopoetik kök hücre nakli yapılan lenfomalı hastaların, nakil sonrası kardiyotoksisite gelişimi açısından retrospektif olarak değerlendirilmesi
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Date
2017
Authors
Çelikçi, Sedat
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Publisher
Uludağ Üniversitesi
Abstract
Nüks etmiş lenfomalı hastalarda yüksek doz kemoterapiyi takiben yapılan otolog hematopoietik kök hücre nakli (OHKHN) standart tedavi haline gelmiştir. Ancak bu yöntemle birlikte kardiyotoksisitenin de içinde bulunduğu çeşitli toksik yan etkiler meydana gelmektedir. BEAM (melfalan, sitozin arabinozid, etoposid, karmustin) protokolü kullanılarak OHKHN yapılan nüks lenfomalı hastalarda klinik olarak kardiyotoksisite gelişim sıklığının değerlendirildiği (insidans, risk faktörleri, kardiyak toksisite sonuçları) yeterli miktarda yayın bulunmaması nedeniyle bu çalışmayı yapmayı planlandık. Uludağ Üniversitesi Hematoloji Bilim Dalı, Kemik İliği Nakil Ünitesinde Ocak 2009–Ekim 2015 tarihleri arasında OHKHN yapılan nüks lenfoma tanılı, 18 yaşından büyük toplam 35 hasta çalışmaya dahil edildi. Hastalar OHKHN sonrası kardiyotoksisite gelişen ve gelişmeyen olmak üzere 2 grupta incelendi. Bu çalışma sonucunda nakil sonrası hastanede kalış süresince gelişen kardiyotoksisite sıklığını ve kardiyotoksisite gelişen ve gelişmeyen hastalar arasında cinsiyet, yaş, hastalık tanısı, hastalık evresi, nakil öncesi kardiyak risk faktörlerine sahip olup olmaması, nakil öncesi aldığı kemoterapi siklus sayıları ve rituximab kullanımı, nakil öncesi radyoterapi alıp almadığı, karnofsky performans skalası, ürün toplanırken kullanılan kriyoprotektif ajan Dimetil sülfoksit (DMSO) miktarı, nakil öncesi ekokardiyodrafi (EKO) ile değerlendirilen sol ventrikül ejeksiyon fraksiyonu (SVEF) değerleri taranarak bu parametreler arasında fark olup olmadığını saptamayı planladık. Kardiyotoksisiler CTCAE V 4.0 sistemine göre değerlendirildiğinde Grade I'den Grade V'e kadar artan şiddetlerde sınıflandırıldı. Nakil sonrası 9 hastada kardiyak olay gelişmiştir. 9 hastanın 1'inde Grade II atrial fibrilasyon (AF), bir diğerinde Grade I bradikardi gelişmiş ve kendiliğinden geri dönmüştür. Bir hastada Grade V miyokard infarktüsü (MI) gelişmiştir ve hasta tedaviye rağmen kaybedilmiştir. Diğer 6 toksisite Grade III-IV gelişmiş olup tedavi ile geri döndürülmüştür. Risk faktörleri açısından kardiyotoksisite gelişen grubun SVEF anlamlı olarak düşük saptanmıştır (p<0,05). Hastalık evreleri açısından her iki grup arasında istatistiksel olarak fark saptanmakla birlikte hastalık evresi artışına bir paralellik göstermemektedir. Diğer parametreler arasında amlamlı bir fark saptanmamıştır.
Autologous hematopoietic stem cell transplantation (AHSCT) following high dose chemotherapy in relapsed lymphoma patients has become the standard of care. However, with this method, various toxic side effects, including cardiotoxicity, occur. We planned to do this study because of the lack of publication in the clinic of the frequency of cardiotoxicity development (incidence, risk factors, cardiac toxicity results) in recurrent lymphoma patients who underwent AHSCT using BEAM (melphalan, cytosine arabinoside, etoposide, karmustin) protocol. A total of 35 patients, aged 18 years or more, diagnosed with recurrent lymphoma who underwent AHSCT between January 2009 and October 2015 were included in the study at the Hematology Science Branch of Uludag University, Bone Marrow Transplant Unit. Patients Cardiotoxicity after AHSCT was investigated in 2 groups as developing and non-developing. The results of this study are as follows: cardiotoxicity incidence during hospital stay after transplantation and gender, age, disease diagnosis, disease stage, cardiac risk factors before transplantation, number of chemotherapy cycles before transplantation and rituximab usage, left ventricular ejection fraction (LVEF) values assessed by pre-transplant echocardiography (ECO) and by using the Karnofsky performance scale, the amount of cryoprotective agent dimetil sulfoxide (DMSO) used during product harvesting, and whether these differences were significant. Cardiotoxicities were graded from Grade I to Grade V, as assessed by the CTCAE V 4,0 system. Cardiac events developed in 9 patients after transplantation. Grade II atrial fibrillation in one of nine patients, Grade I bradycardia in the other developed and returned spontaneously. One patient developed Grade V myocardial infarction and the patient was lost despite treatment. The other 6 toxicity developed in Grade III-IV and returned with treatment. The LVEF of the group with cardiotoxicity was significantly lower in terms of risk factors (p<0,05). In terms of disease stages, there is a statistical difference between the two groups and it is not parallel to the increase of the disease stage. No significant difference was found between the other parameters.
Autologous hematopoietic stem cell transplantation (AHSCT) following high dose chemotherapy in relapsed lymphoma patients has become the standard of care. However, with this method, various toxic side effects, including cardiotoxicity, occur. We planned to do this study because of the lack of publication in the clinic of the frequency of cardiotoxicity development (incidence, risk factors, cardiac toxicity results) in recurrent lymphoma patients who underwent AHSCT using BEAM (melphalan, cytosine arabinoside, etoposide, karmustin) protocol. A total of 35 patients, aged 18 years or more, diagnosed with recurrent lymphoma who underwent AHSCT between January 2009 and October 2015 were included in the study at the Hematology Science Branch of Uludag University, Bone Marrow Transplant Unit. Patients Cardiotoxicity after AHSCT was investigated in 2 groups as developing and non-developing. The results of this study are as follows: cardiotoxicity incidence during hospital stay after transplantation and gender, age, disease diagnosis, disease stage, cardiac risk factors before transplantation, number of chemotherapy cycles before transplantation and rituximab usage, left ventricular ejection fraction (LVEF) values assessed by pre-transplant echocardiography (ECO) and by using the Karnofsky performance scale, the amount of cryoprotective agent dimetil sulfoxide (DMSO) used during product harvesting, and whether these differences were significant. Cardiotoxicities were graded from Grade I to Grade V, as assessed by the CTCAE V 4,0 system. Cardiac events developed in 9 patients after transplantation. Grade II atrial fibrillation in one of nine patients, Grade I bradycardia in the other developed and returned spontaneously. One patient developed Grade V myocardial infarction and the patient was lost despite treatment. The other 6 toxicity developed in Grade III-IV and returned with treatment. The LVEF of the group with cardiotoxicity was significantly lower in terms of risk factors (p<0,05). In terms of disease stages, there is a statistical difference between the two groups and it is not parallel to the increase of the disease stage. No significant difference was found between the other parameters.
Description
Keywords
Lenfoma, Otolog kök hücre nakli, Kardiyotoksisite, Lymphoma, Autologous stem cell transplantation, Cardiotoxicity
Citation
Çelikçi, S. (2017). Otolog hematopoetik kök hücre nakli yapılan lenfomalı hastaların, nakil sonrası kardiyotoksisite gelişimi açısından retrospektif olarak değerlendirilmesi. Yayınlanmamış uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.