Coghlan J G, Handler C E, Kottaridis P D
Department of Cardiology, Royal Free Hospital, Pond Street, Hampstead, London NW3 2QG, UK.
Best Pract Res Clin Haematol. 2007 Jun;20(2):247-63. doi: 10.1016/j.beha.2006.09.005.
The expanding role of haematopoietic stem-cell transplantation (HSCT) renders the previous policy of avoiding transplantation in high-risk cardiac patients obsolete. Patients with amyloid, autoimmune conditions, sickle-cell disease, or thalassaemia, and patients over the age of 60 years are increasingly being offered HSCT. It is evident that the policy of avoiding transplantation in patients with impaired systolic function fails to identify all high-risk patients in such groups, and will deprive some patients of the benefits of HSCT unnecessarily. The development of an appropriate algorithm for cardiac pre-assessment and peri-transplant management is hampered by an inadequate understanding of the predictive value of various tests of cardiovascular function, the rapid evolution of advanced management strategies for cardiac dysfunction, and the development of non-cardiotoxic conditioning regimens. To meet this need we propose that an algorithm based on evidence from other clinical situations - already been found to be successful in the management of HSCT in patients with systemic sclerosis - should be used uniformly, and registry studies should be undertaken to distinguish those aspects of the algorithm that positively help to expand the remit of HSCT from those that add little of value.
造血干细胞移植（HSCT）作用的不断扩大，使得以往避免对高危心脏病患者进行移植的政策过时。患有淀粉样变性、自身免疫性疾病、镰状细胞病或地中海贫血的患者，以及60岁以上的患者越来越多地接受HSCT。显然，避免对收缩功能受损患者进行移植的政策未能识别出这类人群中的所有高危患者，会不必要地剥夺一些患者接受HSCT的益处。由于对各种心血管功能测试的预测价值认识不足、心脏功能障碍先进管理策略的快速演变以及非心脏毒性预处理方案的发展，阻碍了制定适当的心脏预评估和移植围手术期管理算法。为满足这一需求，我们建议统一使用一种基于其他临床情况证据的算法（该算法已被证明在系统性硬化症患者的HSCT管理中取得成功），并应开展注册研究，以区分该算法中有助于积极扩大HSCT适用范围的方面与那些价值不大的方面。
