Abstract 17115: Graft versus Host Disease-associated Pericardial Disease: Incidence, Timing, and Treatment Options
INTRODUCTION: Pericardial disease (PD) is a rare manifestation of chronic graft versus host disease (GVHD). Isolated cases have been reported, but risk factors, biomarkers, treatment strategies, and outcomes have never been examined.
HYPOTHESIS: GVHD-related PD is associated with the tapering of immunosuppressive therapy (IST), and aggressively treated patients fare worse than more conservative therapy.
METHODS: Patients undergoing allogeneic hematopoietic stem cell transplant (aSCT) at a single center between 1996-2012 were identified as having pericardial effusion, tamponade, or effusive-constrictive pericarditis associated with GVHD. Individual laboratory, echocardiographic, hemodynamic, and imaging findings were analyzed. Patient outcomes were assessed in relation to their presentation and the therapy chosen.
RESULTS: Of the 896 aSCT procedures, 19 met criteria for inclusion - 18 patients had pericardial effusion, 5 tamponade, and 4 effusive-constrictive pericarditis. PD occurred in the setting of recent IST taper in 12 of the 19 cases. A significant increase in blood monocytes and decrease in serum albumin were identified at diagnosis compared with pre-diagnosis. Hemodynamic and imaging findings are presented in Table 1. 17 patients were treated with steroids either alone (10) or in combination with pericardial window (4), pericardiocentesis (6), or pericardiectomy (2). Of the 8 deaths, 3 had tamponade at presentation and 3 were treated with invasive surgical procedures. Of the 10 patients with IST only, 4 died and 6 demonstrated partial or complete response.
CONCLUSIONS: GVHD-associated PD should be suspected in symptomatic patients undergoing IST taper. Most patients have characteristic findings with imaging and hemodynamic studies. Patients presenting with cardiac tamponade, hemodynamic compromise, and those treated surgically seem to fare worse when compared with conservatively treated patients.
- © 2013 by American Heart Association, Inc.