Cardiac conduction abnormalities in patients with breast cancer undergoing high-dose chemotherapy and stem cell transplantation

Abstract

Summary:Cardiac toxicities in 39 consecutive patients with breast cancer receiving high-dose chemotherapy (HDC) with stem cell transplantation were reviewed. All 39 patients received various anthracycline-containing regimens in adjuvant settings and/or for metastatic disease before HDC. As a cytoreductive regimen, all received cyclophosphamide 2000 mg/m 2 and thiotepa 200 mg/m 2 for 3 consecutive days. No immediate fatal toxicities were observed, but one patient developed chronic congestive heart failure and two had transient left ventricular dysfunction. Pericardial effusion was observed in another three patients. ST-T abnormalities during HDC were observed in two patients and arrhythmias were observed in nine, four of which occurred during stem cell infusion (SCI). There were three atrial arrhythmias, two ventricular arrhythmias, and four atrioventricular (AV)-block episodes. Two patients developed advanced and complete AV-block with an asystolic pause. Notably, three patients experienced AV-block with uncontrolled vomiting. No relationship was observed between the cumulative dose of anthracycline and cardiac toxicities during HDC. These results suggest that abnormalities in the conduction system during HDC may be more frequent than previously reported. Vagal reflex secondary to emesis may play an important role in the development of AV-block. Bone Marrow Transplantation (2000) 25, 185-189. Keywords: high-dose chemotherapy; cyclophosphamide; advanced atrioventricular block; cardiac complications Cyclophosphamide (CY) is widely used in stem cell transplantation for its antineoplastic and myeloablative effects. In addition to well-known complications including a syndrome of inappropriate anti-diuretic hormone secretion and hemorrhagic cystitis, cardiac toxicity occurs at a high dose, and includes transient changes on electrocardiogram (ECG), arrhythmias, pericardial effusion, myocarditis and Correspondence: Dr K Tobinai, Department of Medical Oncology, National Cancer Center Hospital, 5-1-1, Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan 2 Present address: First Department of Internal Medicine, Nagoya University School of Medicine, Nagoya, Japan Received 31 March 1999; accepted 27 July 1999 congestive heart failure (CHF). Cardiac toxicity caused by CY is often fatal. 1-9 The incidence of acute CHF was 17% to 28% in patients who received CY for bone marrow transplantation (BMT), [2][3][4][5]7 and this correlated with the dose of CY administered per day. 6,7 Concerning arrhythmias induced by CY, supraventricular and ventricular origins were commonly observed. 8,9 However, high-grade heart block has rarely been reported. 10,11 In this study, we retrospectively reviewed our experience of cardiac toxicities induced by high-dose chemotherapy (HDC) including CY in patients with breast cancer. Our review of this well-known complication by continuous monitoring revealed a rather higher incidence of abnormalities in the conduction system. Patients and methods Patients and pretransplant consolidation chemotherapyWe reviewed the...

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