Cardiac Systolic Function in Patients Receiving Hematopoetic Stem Cell Transplantation: Risk Factors for Posttransplantation Cardiac Toxicity G.T. Sucak, Z.N. Ozkurt, Z. Akı, M. Yag  cı, A. Çengel, and R. Haznedar ABSTRACT One hundred eleven patients who received 125 hematopoetic stem cell transplantations (HSCT) with myeloablative conditioning regimens were retrospectively evaluated for the development of cardiac toxicity (CT). The aims of this study were to assess the frequency of cardiac complications in patients receiving HSCT and to investigate the value of pretransplantation variables to predict posttransplantation CT. Severe grade III–IV CT was not observed in this cohort, in whom pretransplantation eligibility criteria excluded the patients with a left ventricular ejection fraction (LVEF) of 50% or less. Grade I–II CT was seen in 13.4% patients. Patients with a history of previous mediastinal radiotherapy, high doses of anthracycyclines, and a longer interval between diagnosis and treatment were found to have higher risk of developing CT. Pretransplantation ferritin levels and the type of HSCT did not seem to have an effect on posttransplantation cardiac complications. Our results indicated that CT was managable in patients with a LVEF of at least 50%. H EMATOPOETIC stem cell transplantation (HSCT) has an expanding role in the treatment of benign and malignant hematological disorders. However, HSCT re- mains a procedure with high treatment-related mortality. Assessment of organ function prior to HSCT has been a routine part of the pretransplantation work-up for more than 30 years; it is considered to be an important predictor of regimen-related toxicity, which mainly includes renal, respiratory, hepatic, and mucosal injury. HSCT has been associated with a low prevalence of cardiac mortality be- cause this treatment modality is usually confined to low– cardiac risk patients. 1 Although the correlation of pretrans- plantation function and posttransplantation cardiac toxicity (CT) is questioned, several reports have confirmed that patients with a left ventricular ejection fraction (LVEF) of 50% show a greater incidence of CT. 1 Determining the risk factors and transplanting vulnerable patients with im- paired cardiac function, with noncardiotoxic protocols, could further decrease CT among HSCT patients. Acute cardiac problems, such as arrhythmias, heart failure, and cardiac tamponade, have been reported in 1%–9% of patients in various studies. 1–5 High-dose cyclophospha- mide 6,7 and/or total-body irradiation (TBI) are treatment modalities known to be associated with CT. 8 High-dose anthracycline before transplantation has also been reported to be a cardiac risk factor for HSCT patients. 2,3 Cardiac performance has been assessed by measuring LVEF with echocardiography or radionuclide ventriculography (RVG). However, it remains unclear whether LVEF is sufficient to assess the risk of CT, or whether a low LVEF per se is an obstacle for HSCT. 2,6,9 At the same time, the optimal method for cardiac follow-up after transplantation is still not clear; there are no adequate studies documenting long-term cardiac function. In this retrospective analysis, we sought to determine the acute CT frequency, the risk factors for CT, and changes in cardiac functions evaluated with both (RVG) and echocardiography during long-term follow-up among a cohort of HSCT patients. MATERIALS AND METHODS Patients We retrospectively analyzed the acute CT in 111 consecu- tive patients (43 females, 68 males) who had undergone 125 HSCTs, including 14 patients with double/tandem trans- plants between September 2003 and December 2006. Of the 125 HSCT, 52 were autologous and 73 allogeneic trans- From the Department of Hematology, Gazi University Faculty of Medicine, Ankara, Turkey. Address reprint requests to Dr Gulsan T. Sucak, Gazi Univer- sity Faculty of Medicine, Ankara, Cankaya 06500, Turkey. E-mail: aysucak@gazi.edu.tr 0041-1345/08/$–see front matter © 2008 by Elsevier Inc. All rights reserved. doi:10.1016/j.transproceed.2007.11.077 360 Park Avenue South, New York, NY 10010-1710 1586 Transplantation Proceedings, 40, 1586 –1590 (2008)