High-dose cyclophosphamide caused a transient decrease in LVEF from 53% at baseline to 49% at day 12 (P=0.009) and significant acute increases in plasma natriuretic peptides.
Cohort (n=30)
Does high-dose cyclophosphamide induce acute cardiac dysfunction in adult non-Hodgkin's lymphoma patients?
High-dose cyclophosphamide causes transient, subclinical systolic dysfunction in NHL patients, which is sensitively detected by serial measurements of natriuretic peptides.
Absolute Event Rate: 49% vs 53%
p-value: p=0.009
OBJECTIVES: 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). METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
Kuittinen et al. (Wed,) conducted a cohort in non-Hodgkin's lymphoma (n=30). High-dose cyclophosphamide (CY) vs. Baseline (pre-treatment) was evaluated on Left ventricular ejection fraction (LVEF) at day 12 compared to baseline (p=0.009). High-dose cyclophosphamide caused a transient decrease in LVEF from 53% at baseline to 49% at day 12 (P=0.009) and significant acute increases in plasma natriuretic peptides.