Kuittinen T, Jantunen E, Vanninen E, Mussalo H, Vuolteenaho O, Ala-Kopsala M, Nousiainen T, Hartikainen J
Department of Medicine, Kuopio University Hospital, Kuopio, Finland.
Eur J Haematol. 2006 Aug;77(2):120-7. doi: 10.1111/j.1600-0609.2006.00687.x.
Limited data are available on the cardiac effects of high-dose cyclophosphamide (CY) in patients with non-Hodgkin's lymphoma (NHL). We prospectively assessed the cardiac effects of high-dose CY in 30 adult NHL patients receiving CY 6 g/m(2) as part of BEAC high-dose therapy (HDT).
Radionuclide ventriculography (RVG) and plasma natriuretic peptide (NT-proANP, NT-proBNP) measurements were performed simultaneously prior to BEAC at baseline (d - 7), 12 days (d + 12) and 3 months (m + 3) after stem cell infusion (D0). In addition to these time points, natriuretic peptides were measured 2 days before (d - 2) and 1 week (d + 7) after stem cell infusion.
Left ventricular ejection fraction (LVEF) decreased from d - 7 (53% +/- 2%) to d + 12 (49% +/- 2%, P = 0.009). However, no significant change in cardiac diastolic function was observed. The LVEF returned towards baseline by m + 3. Plasma NT-proANP and NT-proBNP increased significantly from baseline (445 +/- 65 pmol/L and 129 +/- 33 pmol/L) to d - 2 (1,127 +/- 142 pmol/L, P < 0.001 and 624 +/- 148 pmol/L, P < 0.001, respectively). Thereafter, they started to decrease, but on d + 7 NT-proANP (404 +/- 157 pmol/L, P = 0.048) and NT-proBNP (648 +/- 125 pmol/L, P = 0.015) were still significantly higher than at baseline. On d + 12 and m + 3 they no longer differed from baseline.
Our findings suggest that high-dose CY results in acute, subclinical systolic dysfunction in NHL patients previously treated with anthracyclines. Natriuretic peptides seem to be more sensitive than LVEF to reflect this transient cardiac effect. Serial measurements of natriuretic peptides might be a useful tool to assess cardiac effects of high-dose CY.
关于高剂量环磷酰胺（CY）对非霍奇金淋巴瘤（NHL）患者心脏影响的数据有限。我们前瞻性评估了30例接受6 g/m²CY作为BEAC高剂量治疗（HDT）一部分的成年NHL患者中高剂量CY的心脏影响。
在基线（第-7天）、干细胞输注（D0）后12天（第+12天）和3个月（第+3个月）时，于BEAC治疗前同时进行放射性核素心室造影（RVG）和血浆利钠肽（NT-proANP、NT-proBNP）测量。除这些时间点外，在干细胞输注前2天（第-2天）和后1周（第+7天）测量利钠肽。
左心室射血分数（LVEF）从第-7天（53%±2%）降至第+12天（49%±2%，P = 0.009）。然而，未观察到心脏舒张功能有显著变化。到第+3个月时，LVEF恢复至基线水平。血浆NT-proANP和NT-proBNP从基线（445±65 pmol/L和129±33 pmol/L）显著升高至第-2天（1127±142 pmol/L，P < 0.001和624±148 pmol/L，P < 0.001）。此后，它们开始下降，但在第+7天，NT-proANP（404±157 pmol/L，P = 0.048）和NT-proBNP（648±125 pmol/L，P = 0.015）仍显著高于基线水平。在第+12天和第+3个月时，它们与基线水平无差异。
我们的研究结果表明，高剂量CY会导致先前接受过蒽环类药物治疗的NHL患者出现急性、亚临床收缩功能障碍。利钠肽似乎比LVEF更敏感，能反映这种短暂的心脏效应。连续测量利钠肽可能是评估高剂量CY心脏影响的有用工具。
