Ayfer GEDÜK, Elif BİRTAŞ ATEŞOĞLU, Özgür MEHTAP, Pınar TARKUN, Esra DEMİRSOY TERZİ, Meral ULUKÖYLÜ MENGÜÇ, Zafer GÜLBAŞ, İrem KARAÜZÜÜM, Abdullah HACIHANEFİOĞLU

Is The Autologous Stem Cell Transplantation Cardiotoxic or Cardioprotective in Patients With Multiple Myeloma?

INTRODUCTION: Autologous stem cell transplantation (ASCT) is an effective treatment option in patients with Multiple Myeloma (MM). There is a concern about development of cardiac complications following ASCT because of the chemotherapeutics which are used. In this study we aimed to evaluate late cardiac effects of ASCT in patients with MM. METHODS: The patients who presented to the our institution with diagnosis of MM and underwent ASCT were studied retrospectively. Thirty cases who had routine pretransplant and posttransplant first year echocardiographic examinations were examined. The data of left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic diameter (LVESD), left ventricular ejection fraction (LVEF), E wave, A wave and E/A index were collected. RESULTS: The increase in posttransplant LVEF (mean±SD, 66.66±8.5 %) as a marker of left ventricular systolic function compared with pretransplant LVEF (62.46±4.51 %) was statistically significant (p=.013). In subgroup analyses, the increase in LVEF was greater in patients who underwent tandem ASCT (5.25±5.2 %) compared with did not (4.72±8.68 %), but the difference was not statistically significant (p=.872). There were significant decreases in posttransplant LVEDD (45.4±5.8 mm) and LVESD (27.3±4.9 mm) which was evidence of the amelioration of left ventricular diastolic dysfunction, compared with pretransplant LVEDD (48.9±4.1 mm) and LVESD (31.1±4.1 mm) (p=.044, p=.041, respectively). DISCUSSION AND CONCLUSION: This is the first study in literature that demonstrated improved systolic and diastolic cardiac functions at late-term of ASCT in patients with MM. These results are important in terms of showing the systemic effect of stem cell during the course of ASCT.

Multiple Myelom Hastalarında Otolog Kök Hücre Nakli Kardiyotoksik Mi, Kardiyoprotektif Mi?

GİRİŞ ve AMAÇ: Multiple myelom (MM) hastalarında otolog kök hücre nakli (OKHN) etkili bir tedavi seçeneğidir. Kullanılan kemoterapötikler nedeniyle OKHN sonrası kardiyak yan etkilerin gelişebileceğine dair endişeler mevcuttur. Bu çalışmada MM hastalarında OKHN sonrası geç kardiyak etkilerin değerlendirilmesini amaçladık. YÖNTEM ve GEREÇLER: Kurumumuza MM tanısı ile başvuran ve OKHN yapılmış olan hastalar retrospektif olarak incelendi. Rutin pretransplant ve nakil sonrası birinci yıl ekokardiyografik değerlendirmeleri olan 30 hasta çalışmaya alındı. Sol ventrikül diastol sonu çapı (LVEDD), sol ventrikül sistol sonu çapı (LVESD), sol ventrikül ejeksiyon fraksiyonu (LVEF), E dalgası, A dalgası ve E/A indeksine ait veriler toplandı. BULGULAR: Sol ventrikül sistolik fonksiyonunun göstergesi olarak nakil sonrası LVEF’deki (ortalama±SD, 66.66±8.5 %) artış, nakil öncesi LVEF (62.46±4.51 %) ile karşılaştırıldığında istatistiksel olarak anlamlıydı (p=.013). Alt grup analizlerinde LVEF’deki artış tandem nakil olan grupta (5.25±5.2 %), tek nakil olan gruba (4.72±8.68 %) göre daha yüksekti ancak istatistiksel anlamlılık sağlanamadı (p=.872). Sol ventrikül diyastolik disfonksiyonundaki düzelmenin kanıtı olarak nakil sonrası LVEDD (45.4±5.8 mm) ve LVESD (27.3±4.9 mm) değerlerinde nakil öncesi LVEDD (48.9±4.1 mm) ve LVESD (31.1±4.1 mm) değerlerine göre istatistiksel olarak anlamlı düşüş tespit edildi (p=.044, p=.041, sırasıyla). TARTIŞMA ve SONUÇ: Bu çalışma literatürde MM’li hastalarda OKHN sonrası geç dönemde artmış kardiyak sistolik ve diyastolik fonksiyonları gösteren ilk çalışmadır. Bu sonuçlar OKHN sürecinde kök hücrenin sistemik etkilerini göstermesi açısından önemlidir

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