Avaliação de injúria cardíaca pós quimioterapia em alta dose para transplante autólogo de células-tronco hematopoiéticas

Abstract

Patients who receive autologous hematopoietic stem cell transplantation (AHSCT) have a higher cumulative incidence of cardiovascular complications. Among the risk factors associated with these complications are chemotherapy administered in conditioning, pre-transplant therapy and pre-existing cardiovascular risk factors. Thus, we aim to evaluate the incidence and the degree of early cardiotoxicity after conditioning for autologous hematopoietic stem cell transplantation. All patients undergoing autologous hematopoietic stem cell transplantation at the University Hospital of Universidade Federal de Juiz de Fora and Hospital Monte Sinai between March 2018 and May 2019 were evaluated, and the patients who underwent the procedure at University Hospital in October 2019. Data related to physical examination before and after conditioning chemotherapy and results of routine propaedeutic examinations were collected, and troponin I dosage was requested before conditioning, at the beginning of neutropenia and approximately 30 days after hematopoietic stem cell infusion. An echocardiogram was performed 30 to 60 days after autologous hematopoietic stem cell transplantation, classifying the changes according to the Brazilian Cardio-Oncology Directive of the Brazilian Society of Cardiology. Of the 33 patients evaluated, 7 (21.2%) had cardiotoxicity by echocardiogram, 4 of which had grade I cardiotoxicity and 3 patients had grade II. One patient had a change in the TnI test in nadir after chemotherapy and one patient had a positive test 30 days after transplantation. Both were not associated with an early change in echocardiogram performed after autologous hematopoietic stem cell transplantation. There was a reduction from 71.53% to 64.75% between the mean left ventricular ejection fraction before and after conditioning (p = 0.00013). Pearson's correlation was shown to be positive (0.40) when the administration of more than 9g of cyclophosphamide and cardiotoxicity was evaluated. Clinical changes in the cardiovascular system demonstrate a relationship with advanced staging and more than one year between diagnosis and autologous hematopoietic stem cell transplantation (p = 0.01, in both). Specific signs of congestion correlate with radiotherapy in the cardiac area and use of more than 400mg of doxorubicin before autologous hematopoietic stem cell transplantation (p = 0.02 and p = 0.01, respectively). Our findings allow us to conclude that cardiac injury is an event present in patients undergoing autologous hematopoietic stem cell transplantation and is more associated with pre-transplant therapy than conditioning chemotherapy in our assessment. However, studies with a larger number of patients and standardization of tests capable of identifying cardiotoxicity early, before the lesion becomes irreversible, are still necessary.