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

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].