Karasek Magdalena, Majcherek Maciej, Kuszczak Bartłomiej, Szeremet Agnieszka, Chyrko Olga, Wróbel Tomasz, Czyż Anna
Department of Haematology, Blood Neoplasms and Bone Marrow Transplantation Wroclaw Medical University.
Department of Haematology, Blood Neoplasms and Bone Marrow Transplantation Wroclaw Medical University.
Clin Hematol Int. 2024 Mar 4;6(1):88-95. doi: 10.46989/001c.94362. eCollection 2024.
Cyclosporine A (CSA) is a commonly used immunosuppressive agent for the prophylaxis of graft-versus-host disease following allogeneic hematopoietic stem cell transplantation (alloHSCT). While tachycardia is a known adverse effect of CSA, bradycardia remains a phenomenon rarely described in the literature. We conducted a retrospective evaluation of the incidence of bradycardia in patients after alloHSCT treated with CSA between January 2020 and February 2023 at our center. Out of 206 patients, sinus bradycardia following the administration of CSA was observed in 6 (2.9%), comprising 3 women and 3 men, with the median age of 55 years (range: 20-65). The underlying diseases were myeloid malignancies in 4 and aggressive lymphoma in 2 patients. The patients received grafts from a matched unrelated (n=5) or a haploidentical family donor (n=1) following various conditioning regimens. Coexisting cardiovascular disorders were found in 5 of the 6 patients. All patients experienced symptomatic bradycardia within 1-4 days (median 2 days) after CSA introduction, which persisted until CSA withdrawal. One patient required treatment with atropine. All patients continued their immunosuppressive therapy with tacrolimus, which was well-tolerated Our study indicates CSA as a causative factor of sinus bradycardia in a small percentage of alloHSCT patients receiving CSA as graft-versus host disease (GvHD) prophylaxis. Importantly, these patients did not experience any cardiac complications when switched to tacrolimus. Although further research on the effects of CSA on heart automatation is needed, our single-center experience can help prompt diagnosis and therapeutic intervention in daily clinical practice.
环孢素A（CSA）是一种常用的免疫抑制剂，用于预防异基因造血干细胞移植（alloHSCT）后的移植物抗宿主病。虽然心动过速是CSA已知的不良反应，但心动过缓在文献中仍然是一种很少被描述的现象。我们对2020年1月至2023年2月在我们中心接受CSA治疗的alloHSCT患者心动过缓的发生率进行了回顾性评估。在206例患者中，6例（2.9%）在使用CSA后出现窦性心动过缓，其中包括3名女性和3名男性，中位年龄为55岁（范围：20 - 65岁）。基础疾病为4例髓系恶性肿瘤和2例侵袭性淋巴瘤。患者在接受各种预处理方案后，从匹配的无关供者（n = 5）或单倍体相合的家族供者（n = 1）处接受了移植。6例患者中有5例存在并存的心血管疾病。所有患者在引入CSA后1 - 4天（中位2天）内出现症状性心动过缓，持续至停用CSA。1例患者需要阿托品治疗。所有患者继续使用他克莫司进行免疫抑制治疗，耐受性良好。我们的研究表明，在一小部分接受CSA预防移植物抗宿主病（GvHD）的alloHSCT患者中，CSA是窦性心动过缓的致病因素。重要的是，这些患者换用他克莫司后未出现任何心脏并发症。尽管需要进一步研究CSA对心脏自律性的影响，但我们的单中心经验有助于在日常临床实践中进行及时诊断和治疗干预。
