[The Role of Laboratory Medicine in Hematopoietic Stem Cell Transplantation "Echocardiogram"].

Mitsutaka Nishimoto, Junichi Yoshikawa
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引用次数: 0

Abstract

Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is a curative therapy for hematologic ma- lignancies. However, there are some potentially fatal complications, including graft-versus-host disease or infections, and transplant-related mortality is still high. One of the life-threatening complications related to allo-HSCT is cardiotoxicity. There are several causes of cardiotoxicity, such as pre-transplant chemothera- py, conditioning chemotherapy, cytokine storms due to sepsis or allogeneic immune reactions, rapid altera- tion of body fluid, and ischemic heart disease caused by transplant-associated thrombotic microangiopathy or calcineurin inhibitors. Echocardiography is a very useful and convenient method when assessing the cardiac function in daily clin- ics. The ejection fraction is a useful surrogate marker of the cardiac systolic function, and the trans-mitral valve inflow pattern is a useful surrogate marker of the cardiac diastolic function. There are several causes of cardiotoxicity during the course of allo-HSCT. In the pre-phase of allo-HSCT, the cumulative dose of anthracycline before transplantation is correlated with the rate of cardiac complications. In the acute phase of allo-HSCT, we should bear in mind cyclophosphamide-induced cardiotoxicity. Since these cardiotoxicities sometimes cannot be detected in the cardiac systolic function but can in the diastolic one, we should evaluate the cardiac diastolic function such as trans-mitral valve inflow pattern with echocar- diograms. In addition, some types of conditioning chemotherapies could have significant impacts on cardiac functions even in the chronic phase of allo-HSCT. In conclusion, it is very important to assess cardiac systolic and diastolic functions using echocardiograms for the improved management of cardiotoxicity in allo-HSCT recipients. [Review].

[造血干细胞移植“超声心动图”中的检验医学作用]。
同种异体造血干细胞移植是治疗血液病的一种有效方法。然而,存在一些潜在的致命并发症,包括移植物抗宿主病或感染,并且与移植相关的死亡率仍然很高。与同种异体造血干细胞移植相关的危及生命的并发症之一是心脏毒性。心脏毒性有几种原因,如移植前化疗、调理化疗、败血症或同种异体免疫反应引起的细胞因子风暴、体液的快速改变、移植相关血栓性微血管病变或钙调磷酸酶抑制剂引起的缺血性心脏病。超声心动图是日常临床评估心功能的一种非常有用和方便的方法。射血分数是心脏收缩功能的一个有用的替代指标,经二尖瓣流入模式是心脏舒张功能的一个有用的替代指标。在同种异体造血干细胞移植过程中,有几种原因导致心脏毒性。在同种异体造血干细胞移植前期,移植前蒽环类药物的累积剂量与心脏并发症的发生率相关。在同种异体造血干细胞移植的急性期,我们应该牢记环磷酰胺诱导的心脏毒性。由于这些心脏毒性有时不能在心脏收缩功能中检测到,但可以在心脏舒张功能中检测到,因此我们应该评估心脏舒张功能,例如用超声图检查二尖瓣流入模式。此外,某些类型的调节性化疗甚至在同种异体造血干细胞移植的慢性期也可能对心功能产生显著影响。总之,使用超声心动图评估心脏收缩和舒张功能对于改善同种异体造血干细胞移植受者心脏毒性的管理是非常重要的。(审查)。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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