Author/Editor		Koželj, Mirta; Zver, Samo; Zadnik, Vesna; Černelč, Peter
Title		Echocardiographic assessment of the cardiac toxicity of high dose cyclophosphamide and melphalan
Translated title		Ehokardiografska ocena toksičnosti visokih odmerov ciklofosfamida in melfalana
Type		članek
Source		Slov Pediatr
Vol. and No.		Letnik 5, št. 1
Publication year		2008
Volume		str. 22-7
Language		eng
Abstract		8ackground. Tandem autologous hematopoetic stem cell transplantation (HSC) has been recognized as an effective treatment modality in patients with multiple myeloma. During the treatment period, patients received high-dose cyclophosphamide followed by two myeloablative dosages of melphalan. There are very scarce data about potential treatment-related cardiotoxic side effects. Methods. The study included 30 patients with multiple myeloma who were treated with three cycles of chemotherapy followed by high-dose cyclophosphamide (cycle C`n and two autologous tandem HSCT treatments with melphalan (cycle MEL I and cycle MEL II). All patients underwent conventional and tissue Doppler echocardiographic examinations prior to cyclophosphamide therapy (Echo 0), before the MEL I cycle (Echo 1), before the MEL II cycle (Echo 2) and three months after the completion of therapy (Echo 3). Results. Concerning the parameters of left ventricular diastolic function, the duration of a wave in the Doppler pulmonary vein flow signal increased significantly compared with its basal value (Echo 0/Echo 1: p=0.008, Echo 0/Echo 3; p=0.026). There was also a significant decrease in the A/a ratio of flow velocities during chemotherapy (Echo 0/Echo 1: p=0.002, Echo 0/Echo 3: p<0.0001). Early diastolic tissue Doppler velocities (Em) decreased significantly during individual cycles of chemotherapy (p=0.006). A significant post-treatment increase in the incidence of mitral regurgitation was observed (Echo 0/Echo 3; p=0.003). Pericardial effusion occurred in six patients (20.6 %). Conclusions. Treatment of multiple myeloma patients with tandem autologous HSCT is cardiotoxic. Doppler echocardiography studies revealed worsening of left ventricular diastolic function and occurrence of functional mitral regurgitation.
Descriptors		HEMATOPOIETIC STEM CELL TRANSPLANTATION CYCLOPHOSPHAMIDE MELPHALAN ECHOCARDIOGRAPHY MULTIPLE MYELOMA MITRAL VALVE INSUFFICIENCY