natriuretic-peptide--brain and Lymphoma

Cardiac failure is a known complication of haemopoietic stem cell transplantation (HSCT) and is often difficult to diagnose as patients may have multiple medical problems. Since brain natriuretic peptide (BNP) is largely a hormone of cardiac ventricular origin and is released early in the course of ventricular dysfunction, we have examined the value of serial plasma BNP levels for detecting cardiac failure in patients undergoing cytotoxic conditioning for HSCT. Fifteen patients undergoing HSCT were evaluated (10 undergoing autologous HSCT; five undergoing allogeneic HSCT). BNP was measured by radioimmunoassay prior to therapy and weekly for 5 weeks. Seven patients had a significant rise in BNP level (above a previously established threshold of 43 pmol/l associated with cardiac failure), occurring 1-4 weeks post commencement of conditioning. In three of these patients, cardiac failure was subsequently diagnosed clinically 3, 9 and 23 days after a BNP level of 43 pmol/l had been detected. These three patients had the highest peak BNP levels for the group and in each case elevation in BNP level occurred for a period exceeding 1 week. Although numbers were relatively small, a BNP >43 pmol/l was significantly associated with the inclusion of high-dose cyclophosphamide in the preparative regimen (P = 0.02). BNP levels showed no relationship to febrile episodes. In conclusion, these results show that plasma BNP may be used as a marker for early detection of cardiac dysfunction in patients undergoing HSCT, particularly if levels are increased for periods exceeding 1 week. Measurement of BNP during HSCT may be helpful in patients at risk of cardiac failure, in complex clinical situations and in monitoring the cardiotoxicity of preparative regimens.

Topics: Adolescent; Adult; Antineoplastic Combined Chemotherapy Protocols; Child; Cyclophosphamide; Hematopoietic Stem Cell Transplantation; Humans; Leukemia; Lymphoma; Middle Aged; Natriuretic Peptide, Brain; Rhabdomyosarcoma; Transplantation Conditioning; Ventricular Dysfunction, Left

The use of posttransplant cyclophosphamide (PT-Cy) has contributed significantly to the success of haploidentical hematopoietic cell transplantation (HCT). Furthermore, several studies have shown promising results in the human leukocyte antigen-matched setting. However, the use of high-dose cyclophosphamide has been associated with the development of cardiomyopathy. There is a paucity of data concerning posttransplant cardiac complications in patients undergoing PT-Cy-based HCT.. A retrospective analysis of 176 patients undergoing HCT with PT-Cy was performed. The overall survival, left ventricular ejection fractions, brain natriuretic peptide levels, and cardiac comorbidities were reviewed. The associations between comorbidities and the onset of heart failure were assessed with a Cox proportional hazards model.. Pretransplant cardiomyopathy was found in 16 patients (9.1%) but had no effect on their posttransplant overall survival. Thirty-five patients (21.9%) developed posttransplant cardiomyopathy, which correlated with increased mortality, but this was not statistically different from the frequency-matched non-PT-Cy cohort. The majority of these cardiomyopathies occurred in the setting of an infectious milieu. An age greater than 60 years and an HCT comorbidity index score equal to or greater than 4 were the only risk factors that correlated with posttransplant cardiomyopathy.. The presence of pretransplant cardiomyopathy does not negatively affect overall survival for patients who undergo HCT with PT-Cy. Furthermore, cardiomyopathy in PT-Cy patients is not caused by PT-Cy but is mostly concurrent with infectious complications and is associated with reduced overall survival. Traditional cardiovascular risk factors do not fully predict the occurrence of posttransplant cardiomyopathy. Future research is required to unravel predictive factors for cardiomyopathy after PT-Cy-based HCT. Cancer 2017;123:1800-1809. © 2017 American Cancer Society.

Topics: Adult; Aged; Anemia, Aplastic; Antineoplastic Agents, Alkylating; Bone Marrow Diseases; Cardiomyopathies; Cardiovascular Diseases; Comorbidity; Cyclophosphamide; Echocardiography; Female; Heart Failure; Hematopoietic Stem Cell Transplantation; Humans; Leukemia; Lymphoma; Male; Middle Aged; Multiple Myeloma; Myelodysplastic Syndromes; Myeloproliferative Disorders; Natriuretic Peptide, Brain; Peptide Fragments; Proportional Hazards Models; Retrospective Studies; Stroke Volume; Survival Rate; Transplantation Conditioning; Young Adult

Topics: Biomarkers; Diagnosis, Differential; Fatal Outcome; Heart Neoplasms; Humans; Lymphoma; Male; Myocardial Infarction; Natriuretic Peptide, Brain

The goal of this study was to determine if low to moderate doses of anthracycline-based chemotherapy (Anth-bC) are associated with subclinical cardiovascular (CV) injury.. Cancer survivors who receive Anth-bC experience premature CV events. It is unknown whether low to moderate doses of anthracyclines promote early subclinical CV disease manifested by deteriorations in left ventricular ejection fraction (LVEF) or increases in aortic stiffness, or if these doses are associated with changes in quality of life (QOL).. In 53 men and women with breast cancer, leukemia, or lymphoma, we assessed left ventricular volumes, LVEF, circumferential strain, aortic pulse wave velocity, late gadolinium enhancement, serum B-type natriuretic peptide, troponin I, and the impact of treatment on QOL before and 1, 3, and 6 months after receipt of Anth-bC.. Participants averaged 50 ± 2 (range 19 to 80) years in age, 58% were women, 17% were black, and they each received a range of 50 to 375 mg/m(2) of doxorubicin-equivalent chemotherapy. Left ventricular end-systolic volume (48 ± 3 ml to 54 ± 3 ml; p = 0.02), left ventricular strain (-17.7 ± 0.4 to -15.1 ± 0.4; p = 0.0003), pulse wave velocity (6.7 ± 0.5 m/s to 10.1 ± 1 m/s; p = 0.0006), and QOL deterioration (15.4 ± 3.3 to 28.5 ± 3.9; p = 0.008) increased, whereas LVEF (58 ± 1% to 53 ± 1%; p = 0.0002) decreased within 6 months after low to moderate doses of Anth-bC. All findings persisted after accounting for age, gender, race (white/black), doxorubicin-equivalent dose, doxorubicin administration technique, comorbidities associated with CV events, and cancer diagnosis (p = 0.02 to 0.0001 for all). There were no new late gadolinium enhancement findings after 6 months.. In these study patients, low to moderate doses of Anth-bC were associated with the early development of subclinical abnormalities of cardiac and vascular function that in other populations are associated with the future occurrence of CV events.

Topics: Adult; Aged; Aged, 80 and over; Anthracyclines; Antibiotics, Antineoplastic; Biomarkers; Breast Neoplasms; Cardiovascular Diseases; Female; Humans; Leukemia; Lymphoma; Magnetic Resonance Imaging; Male; Middle Aged; Natriuretic Peptide, Brain; Predictive Value of Tests; Pulse Wave Analysis; Quality of Life; Risk Factors; Stroke Volume; Surveys and Questionnaires; Time Factors; Troponin I; Vascular Stiffness; Ventricular Function, Left; Young Adult

Anthracyclines are well established as highly efficacious antineoplastic agents for childhood malignancy, but they frequently cause dose-related cardiotoxicity. For this reason, children who have received anthracyclines need periodical cardiac evaluation. The plasma levels of B-type natriuretic peptide (BNP) have been shown to increase in proportion to severity of cardiac dysfunction. N-terminal BNP (NT-pro-BNP) is secreted from the cardiac ventricles in response to volume expansion and pressure overload. The aim of our study was to investigate whether plasma levels of NT-pro-BNP and cardiac troponin I (cTnI) can be used as specific markers for doxorubicin-induced cardiotoxicity in children with malignancy.. We performed the study in Dicle University Hospital, Pediatric Hematology and Oncology clinic. Were measured plasma NT-pro-BNP and cTnI in 31 patients (14 boys and 17 girls) who received doxorubicin-containing chemotherapy for their malignancy at cumulative doses of 30-600 mg/m2, between October 2000 and December 2004. Cardiac evaluation of the patients included recording of electrocardiography and assessment of systolic and diastolic functions of the heart by echocardiography.. Of the 31 patients, 4 (12.9%) had left ventricular dysfunction as assessed by echocardiography. Plasma NT-pro-BNP levels in these patients were significantly elevated in comparison with healthy controls (p<0.001). Plasma NT-pro-BNP levels were significantly elevated in patients with cardiac dysfunction when compared with normal cardiac function (p<0.008). The cTnI levels were found under normal value in all patients.. Measurement of NT-pro-BNP level may be an easy and practical tool, and during treatment may allow earlier-identification of individuals at risk for monitoring cardiac damage. Plasma NT-pro-BNP concentration may be a useful and sensitive indicator of cardiac dysfunction in children receiving doxorubicin therapy.

Topics: Adolescent; Antibiotics, Antineoplastic; Cardiomyopathies; Case-Control Studies; Child; Child, Preschool; Doxorubicin; Female; Humans; Leukemia; Lymphoma; Male; Natriuretic Peptide, Brain; Peptide Fragments; Troponin I; Ultrasonography