Cardiac involvement and treatment-related mortality after non-myeloablative haemopoietic stem-cell transplantation with unselected autologous peripheral blood for patients with systemic sclerosis: a retrospective analysis
Summary Background Autologous haemopoietic stem-cell transplantation (HSCT) benefits patients with systemic sclerosis but has been associated with significant treatment-related mortality and failure to improve diffusion capacity of carbon monoxide (DLCO). We aimed to assess efficacy of HSCT and use...
Gespeichert in:
| Veröffentlicht in: | The Lancet (British edition) 2013-03, Vol.381 (9872), p.1116-1124 |
|---|---|
| Hauptverfasser: | , , , , , , , , , , , , , , , , , |
| Format: | Artikel |
| Sprache: | eng |
| Schlagworte: | |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | 1124 |
|---|---|
| container_issue | 9872 |
| container_start_page | 1116 |
| container_title | The Lancet (British edition) |
| container_volume | 381 |
| creator | Burt, Richard K, Dr Oliveira, Maria Carolina, MD Shah, Sanjiv J, MD Moraes, Daniela A, MD Simoes, Belinda, MD Gheorghiade, Mihai, MD Schroeder, James, MD Ruderman, Eric, MD Farge, Dominique, MD Chai, Z Jessie, BS Marjanovic, Zora, MD Jain, Sandeep, MD Morgan, Amy, NP Milanetti, Francesca, MD Han, Xiaoqiang, MD Jovanovic, Borko, PhD Helenowski, Irene B, PhD Voltarelli, Julio, MD |
| description | Summary Background Autologous haemopoietic stem-cell transplantation (HSCT) benefits patients with systemic sclerosis but has been associated with significant treatment-related mortality and failure to improve diffusion capacity of carbon monoxide (DLCO). We aimed to assess efficacy of HSCT and use of rigorous cardiac screening in this group. Methods We assessed patients with diffuse systemic sclerosis or limited systemic sclerosis and interstitial lung disease who were treated with HSCT as part of a study or on a compassionate basis at Northwestern University (Chicago, IL, USA) or the University of São Paulo (Ribeirão Preto, Brazil). Unselected peripheral blood stem cells were harvested with cyclophosphamide (2 g/m2 ) and filgrastim. The transplant regimen was a non-myeloablative regimen of cyclophosphamide (200 mg/kg) and rabbit anti-thymocyte globulin (rATG; 4·5–6·5 mg/kg). We followed patients up to 5 years for overall survival, relapse-free survival, modified Rodnan skin score, and pulmonary function tests. Findings Five (6%) of 90 patients died from treatment-related causes. Despite standard guidelines that recommend echocardiogram for screening before transplantation, four treatment-related deaths occurred because of cardiovascular complications (one constrictive pericarditis, two right heart failures without underlying infection, and one heart failure during mobilisation), and one death was secondary to sepsis without documented underlying heart disease. Kaplan-Meier analysis showed survival was 78% at 5 years (after eight relapse-related deaths) and relapse-free survival was 70% at 5 years. Compared with baseline, we noted improvements after HSCT in modified Rodnan skin scores at 1 year (58 patients; p |
| doi_str_mv | 10.1016/S0140-6736(12)62114-X |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1348485810</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>S014067361262114X</els_id><sourcerecordid>1322730009</sourcerecordid><originalsourceid>FETCH-LOGICAL-c594t-b5f389dc4492732d55a309136c5e6c8768f6e9009757d59e2b0788618e3857163</originalsourceid><addsrcrecordid>eNqNks1u1DAUhSMEokPhEQBLCKksAv6JnYQFCFX8SZVYlEqzszzOTcfFiYPtGTQPy7twM1NaqRtYJVG-e3yuzymKp4y-ZpSpN-eUVbRUtVAnjL9SnLGqXN4rFqyqq1JW9fJ-sbhBjopHKV1RSitF5cPiiAuhhFLVovh9amLnjCVu3Aa_hQHGTMzYkRzB5PmrjOBNho4MIWbjXd4R02eIZAxjOezAB7NCwG2BrA0MYQoOsrMkZRhKC96jlBnT5M2YEQsj-eXymmzGBB7sLGw2OfhwGTaJTBDdtIZoPFn5EDrSh0gmHEMj6TCYdrPyfID1EENy6S0xJELG9wkFZyNmNH6Hfx4XD3rjEzy5fh4XF58-fj_9Up59-_z19MNZaWVb5XIle9G0na2qlteCd1IaQVsmlJWgbFOrplfQUtrWsu5kC3xF66ZRrAHRyJopcVycHHSnGH5uIGU9uDTvbkbAtTQTVVM1smH0P1COHjCqFtEXd9CrsIm42p5ilWxrwZCSB8riBaQIvZ6iG0zcaUb1XBW9r4qee6AZ1_uq6CXOPbtW36wG6G6m_nYDgZfXgEnW-B5TtC7dcvPi6BO55weuN0Gby4jMxTmnTFLKBOWCI_H-QABmsHUQdbKYqIXORUxMd8H90-y7OwrWu9GhrR-wg3R7LzpxTQ8iswbje4Wl-AODRf67</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1321459731</pqid></control><display><type>article</type><title>Cardiac involvement and treatment-related mortality after non-myeloablative haemopoietic stem-cell transplantation with unselected autologous peripheral blood for patients with systemic sclerosis: a retrospective analysis</title><source>MEDLINE</source><source>Elsevier ScienceDirect Journals</source><creator>Burt, Richard K, Dr ; Oliveira, Maria Carolina, MD ; Shah, Sanjiv J, MD ; Moraes, Daniela A, MD ; Simoes, Belinda, MD ; Gheorghiade, Mihai, MD ; Schroeder, James, MD ; Ruderman, Eric, MD ; Farge, Dominique, MD ; Chai, Z Jessie, BS ; Marjanovic, Zora, MD ; Jain, Sandeep, MD ; Morgan, Amy, NP ; Milanetti, Francesca, MD ; Han, Xiaoqiang, MD ; Jovanovic, Borko, PhD ; Helenowski, Irene B, PhD ; Voltarelli, Julio, MD</creator><creatorcontrib>Burt, Richard K, Dr ; Oliveira, Maria Carolina, MD ; Shah, Sanjiv J, MD ; Moraes, Daniela A, MD ; Simoes, Belinda, MD ; Gheorghiade, Mihai, MD ; Schroeder, James, MD ; Ruderman, Eric, MD ; Farge, Dominique, MD ; Chai, Z Jessie, BS ; Marjanovic, Zora, MD ; Jain, Sandeep, MD ; Morgan, Amy, NP ; Milanetti, Francesca, MD ; Han, Xiaoqiang, MD ; Jovanovic, Borko, PhD ; Helenowski, Irene B, PhD ; Voltarelli, Julio, MD</creatorcontrib><description>Summary Background Autologous haemopoietic stem-cell transplantation (HSCT) benefits patients with systemic sclerosis but has been associated with significant treatment-related mortality and failure to improve diffusion capacity of carbon monoxide (DLCO). We aimed to assess efficacy of HSCT and use of rigorous cardiac screening in this group. Methods We assessed patients with diffuse systemic sclerosis or limited systemic sclerosis and interstitial lung disease who were treated with HSCT as part of a study or on a compassionate basis at Northwestern University (Chicago, IL, USA) or the University of São Paulo (Ribeirão Preto, Brazil). Unselected peripheral blood stem cells were harvested with cyclophosphamide (2 g/m2 ) and filgrastim. The transplant regimen was a non-myeloablative regimen of cyclophosphamide (200 mg/kg) and rabbit anti-thymocyte globulin (rATG; 4·5–6·5 mg/kg). We followed patients up to 5 years for overall survival, relapse-free survival, modified Rodnan skin score, and pulmonary function tests. Findings Five (6%) of 90 patients died from treatment-related causes. Despite standard guidelines that recommend echocardiogram for screening before transplantation, four treatment-related deaths occurred because of cardiovascular complications (one constrictive pericarditis, two right heart failures without underlying infection, and one heart failure during mobilisation), and one death was secondary to sepsis without documented underlying heart disease. Kaplan-Meier analysis showed survival was 78% at 5 years (after eight relapse-related deaths) and relapse-free survival was 70% at 5 years. Compared with baseline, we noted improvements after HSCT in modified Rodnan skin scores at 1 year (58 patients; p<0·0001), 2 years (42 patients; p<0·0001), and 3 years (27 patients; p<0·0001) and forced vital capacity at 1 year (58 patients; p=0·009), 2 years (40 patients; p=0·02), and 3 years (28 patients; p=0·004), but total lung capacity and DLCO were not improved significantly after HSCT. Overall mean DLCO was significantly improved in patients with normal baseline echocardiograms (p=0·005) or electrocardiographs (p=0·05). Interpretation Autologous HSCT with a non-myeloablative regimen of cyclophosphamide and rATG with a non-selected autograft results in sustained improvement in skin thickness and forced vital capacity. DLCO is affected by baseline cardiac function. Guidelines for cardiac screening of patients with systemic sclerosis to assess treatment-related risk from pulmonary artery hypertension, primary cardiac involvement, or pericardial disease should be reconsidered and updated. Funding None.</description><identifier>ISSN: 0140-6736</identifier><identifier>EISSN: 1474-547X</identifier><identifier>DOI: 10.1016/S0140-6736(12)62114-X</identifier><identifier>PMID: 23363664</identifier><identifier>CODEN: LANCAO</identifier><language>eng</language><publisher>Kidlington: Elsevier Ltd</publisher><subject>Adolescent ; Adult ; Aged ; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy ; autografting ; Biological and medical sciences ; Blood ; Bone marrow, stem cells transplantation. Graft versus host reaction ; Carbon monoxide ; cardiac output ; Cardiovascular diseases ; Cause of Death ; Colleges & universities ; Compassionate Use Trials ; cyclophosphamide ; Cytomegalovirus ; death ; electrocardiography ; Epidemiology ; Female ; Follow-Up Studies ; General aspects ; guidelines ; heart failure ; Heart Failure - mortality ; Hematopoietic Stem Cell Transplantation - methods ; Hematopoietic Stem Cell Transplantation - mortality ; Humans ; Hypertension ; Internal Medicine ; Kaplan-Meier Estimate ; lung function ; Male ; Medical sciences ; Mental health ; Middle Aged ; Mortality ; Patients ; pericarditis ; Pericarditis, Constrictive - mortality ; pericardium ; Peripheral Blood Stem Cell Transplantation - methods ; Peripheral Blood Stem Cell Transplantation - mortality ; Public health. Hygiene ; Public health. Hygiene-occupational medicine ; pulmonary artery ; Pulmonary Diffusing Capacity - physiology ; Quality of life ; Respiratory function ; Retrospective Studies ; risk ; Scleroderma ; Scleroderma, Diffuse - mortality ; Scleroderma, Diffuse - physiopathology ; Scleroderma, Diffuse - therapy ; Scleroderma, Limited - mortality ; Scleroderma, Limited - physiopathology ; Scleroderma, Limited - therapy ; sclerosis ; screening ; Sepsis - mortality ; Skin ; Stem cells ; Survival ; Total Lung Capacity ; Transfusions. Complications. Transfusion reactions. Cell and gene therapy ; Transplantation ; Transplantation Conditioning ; Transplantation, Autologous ; Transplants & implants ; Ultrasonic imaging ; Veins & arteries ; Vital Capacity - physiology ; Young Adult</subject><ispartof>The Lancet (British edition), 2013-03, Vol.381 (9872), p.1116-1124</ispartof><rights>Elsevier Ltd</rights><rights>2013 Elsevier Ltd</rights><rights>2014 INIST-CNRS</rights><rights>Copyright © 2013 Elsevier Ltd. All rights reserved.</rights><rights>Copyright Elsevier Limited Mar 30, 2013</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c594t-b5f389dc4492732d55a309136c5e6c8768f6e9009757d59e2b0788618e3857163</citedby><cites>FETCH-LOGICAL-c594t-b5f389dc4492732d55a309136c5e6c8768f6e9009757d59e2b0788618e3857163</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S014067361262114X$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=27163000$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/23363664$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Burt, Richard K, Dr</creatorcontrib><creatorcontrib>Oliveira, Maria Carolina, MD</creatorcontrib><creatorcontrib>Shah, Sanjiv J, MD</creatorcontrib><creatorcontrib>Moraes, Daniela A, MD</creatorcontrib><creatorcontrib>Simoes, Belinda, MD</creatorcontrib><creatorcontrib>Gheorghiade, Mihai, MD</creatorcontrib><creatorcontrib>Schroeder, James, MD</creatorcontrib><creatorcontrib>Ruderman, Eric, MD</creatorcontrib><creatorcontrib>Farge, Dominique, MD</creatorcontrib><creatorcontrib>Chai, Z Jessie, BS</creatorcontrib><creatorcontrib>Marjanovic, Zora, MD</creatorcontrib><creatorcontrib>Jain, Sandeep, MD</creatorcontrib><creatorcontrib>Morgan, Amy, NP</creatorcontrib><creatorcontrib>Milanetti, Francesca, MD</creatorcontrib><creatorcontrib>Han, Xiaoqiang, MD</creatorcontrib><creatorcontrib>Jovanovic, Borko, PhD</creatorcontrib><creatorcontrib>Helenowski, Irene B, PhD</creatorcontrib><creatorcontrib>Voltarelli, Julio, MD</creatorcontrib><title>Cardiac involvement and treatment-related mortality after non-myeloablative haemopoietic stem-cell transplantation with unselected autologous peripheral blood for patients with systemic sclerosis: a retrospective analysis</title><title>The Lancet (British edition)</title><addtitle>Lancet</addtitle><description>Summary Background Autologous haemopoietic stem-cell transplantation (HSCT) benefits patients with systemic sclerosis but has been associated with significant treatment-related mortality and failure to improve diffusion capacity of carbon monoxide (DLCO). We aimed to assess efficacy of HSCT and use of rigorous cardiac screening in this group. Methods We assessed patients with diffuse systemic sclerosis or limited systemic sclerosis and interstitial lung disease who were treated with HSCT as part of a study or on a compassionate basis at Northwestern University (Chicago, IL, USA) or the University of São Paulo (Ribeirão Preto, Brazil). Unselected peripheral blood stem cells were harvested with cyclophosphamide (2 g/m2 ) and filgrastim. The transplant regimen was a non-myeloablative regimen of cyclophosphamide (200 mg/kg) and rabbit anti-thymocyte globulin (rATG; 4·5–6·5 mg/kg). We followed patients up to 5 years for overall survival, relapse-free survival, modified Rodnan skin score, and pulmonary function tests. Findings Five (6%) of 90 patients died from treatment-related causes. Despite standard guidelines that recommend echocardiogram for screening before transplantation, four treatment-related deaths occurred because of cardiovascular complications (one constrictive pericarditis, two right heart failures without underlying infection, and one heart failure during mobilisation), and one death was secondary to sepsis without documented underlying heart disease. Kaplan-Meier analysis showed survival was 78% at 5 years (after eight relapse-related deaths) and relapse-free survival was 70% at 5 years. Compared with baseline, we noted improvements after HSCT in modified Rodnan skin scores at 1 year (58 patients; p<0·0001), 2 years (42 patients; p<0·0001), and 3 years (27 patients; p<0·0001) and forced vital capacity at 1 year (58 patients; p=0·009), 2 years (40 patients; p=0·02), and 3 years (28 patients; p=0·004), but total lung capacity and DLCO were not improved significantly after HSCT. Overall mean DLCO was significantly improved in patients with normal baseline echocardiograms (p=0·005) or electrocardiographs (p=0·05). Interpretation Autologous HSCT with a non-myeloablative regimen of cyclophosphamide and rATG with a non-selected autograft results in sustained improvement in skin thickness and forced vital capacity. DLCO is affected by baseline cardiac function. Guidelines for cardiac screening of patients with systemic sclerosis to assess treatment-related risk from pulmonary artery hypertension, primary cardiac involvement, or pericardial disease should be reconsidered and updated. Funding None.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</subject><subject>autografting</subject><subject>Biological and medical sciences</subject><subject>Blood</subject><subject>Bone marrow, stem cells transplantation. Graft versus host reaction</subject><subject>Carbon monoxide</subject><subject>cardiac output</subject><subject>Cardiovascular diseases</subject><subject>Cause of Death</subject><subject>Colleges & universities</subject><subject>Compassionate Use Trials</subject><subject>cyclophosphamide</subject><subject>Cytomegalovirus</subject><subject>death</subject><subject>electrocardiography</subject><subject>Epidemiology</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>General aspects</subject><subject>guidelines</subject><subject>heart failure</subject><subject>Heart Failure - mortality</subject><subject>Hematopoietic Stem Cell Transplantation - methods</subject><subject>Hematopoietic Stem Cell Transplantation - mortality</subject><subject>Humans</subject><subject>Hypertension</subject><subject>Internal Medicine</subject><subject>Kaplan-Meier Estimate</subject><subject>lung function</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Mental health</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Patients</subject><subject>pericarditis</subject><subject>Pericarditis, Constrictive - mortality</subject><subject>pericardium</subject><subject>Peripheral Blood Stem Cell Transplantation - methods</subject><subject>Peripheral Blood Stem Cell Transplantation - mortality</subject><subject>Public health. Hygiene</subject><subject>Public health. Hygiene-occupational medicine</subject><subject>pulmonary artery</subject><subject>Pulmonary Diffusing Capacity - physiology</subject><subject>Quality of life</subject><subject>Respiratory function</subject><subject>Retrospective Studies</subject><subject>risk</subject><subject>Scleroderma</subject><subject>Scleroderma, Diffuse - mortality</subject><subject>Scleroderma, Diffuse - physiopathology</subject><subject>Scleroderma, Diffuse - therapy</subject><subject>Scleroderma, Limited - mortality</subject><subject>Scleroderma, Limited - physiopathology</subject><subject>Scleroderma, Limited - therapy</subject><subject>sclerosis</subject><subject>screening</subject><subject>Sepsis - mortality</subject><subject>Skin</subject><subject>Stem cells</subject><subject>Survival</subject><subject>Total Lung Capacity</subject><subject>Transfusions. Complications. Transfusion reactions. Cell and gene therapy</subject><subject>Transplantation</subject><subject>Transplantation Conditioning</subject><subject>Transplantation, Autologous</subject><subject>Transplants & implants</subject><subject>Ultrasonic imaging</subject><subject>Veins & arteries</subject><subject>Vital Capacity - physiology</subject><subject>Young Adult</subject><issn>0140-6736</issn><issn>1474-547X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>BEC</sourceid><sourceid>BENPR</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNqNks1u1DAUhSMEokPhEQBLCKksAv6JnYQFCFX8SZVYlEqzszzOTcfFiYPtGTQPy7twM1NaqRtYJVG-e3yuzymKp4y-ZpSpN-eUVbRUtVAnjL9SnLGqXN4rFqyqq1JW9fJ-sbhBjopHKV1RSitF5cPiiAuhhFLVovh9amLnjCVu3Aa_hQHGTMzYkRzB5PmrjOBNho4MIWbjXd4R02eIZAxjOezAB7NCwG2BrA0MYQoOsrMkZRhKC96jlBnT5M2YEQsj-eXymmzGBB7sLGw2OfhwGTaJTBDdtIZoPFn5EDrSh0gmHEMj6TCYdrPyfID1EENy6S0xJELG9wkFZyNmNH6Hfx4XD3rjEzy5fh4XF58-fj_9Up59-_z19MNZaWVb5XIle9G0na2qlteCd1IaQVsmlJWgbFOrplfQUtrWsu5kC3xF66ZRrAHRyJopcVycHHSnGH5uIGU9uDTvbkbAtTQTVVM1smH0P1COHjCqFtEXd9CrsIm42p5ilWxrwZCSB8riBaQIvZ6iG0zcaUb1XBW9r4qee6AZ1_uq6CXOPbtW36wG6G6m_nYDgZfXgEnW-B5TtC7dcvPi6BO55weuN0Gby4jMxTmnTFLKBOWCI_H-QABmsHUQdbKYqIXORUxMd8H90-y7OwrWu9GhrR-wg3R7LzpxTQ8iswbje4Wl-AODRf67</recordid><startdate>20130330</startdate><enddate>20130330</enddate><creator>Burt, Richard K, Dr</creator><creator>Oliveira, Maria Carolina, MD</creator><creator>Shah, Sanjiv J, MD</creator><creator>Moraes, Daniela A, MD</creator><creator>Simoes, Belinda, MD</creator><creator>Gheorghiade, Mihai, MD</creator><creator>Schroeder, James, MD</creator><creator>Ruderman, Eric, MD</creator><creator>Farge, Dominique, MD</creator><creator>Chai, Z Jessie, BS</creator><creator>Marjanovic, Zora, MD</creator><creator>Jain, Sandeep, MD</creator><creator>Morgan, Amy, NP</creator><creator>Milanetti, Francesca, MD</creator><creator>Han, Xiaoqiang, MD</creator><creator>Jovanovic, Borko, PhD</creator><creator>Helenowski, Irene B, PhD</creator><creator>Voltarelli, Julio, MD</creator><general>Elsevier Ltd</general><general>Elsevier</general><general>Elsevier Limited</general><scope>FBQ</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>0TT</scope><scope>0TZ</scope><scope>0U~</scope><scope>3V.</scope><scope>7QL</scope><scope>7QP</scope><scope>7RV</scope><scope>7TK</scope><scope>7U7</scope><scope>7U9</scope><scope>7X7</scope><scope>7XB</scope><scope>88A</scope><scope>88C</scope><scope>88E</scope><scope>88G</scope><scope>88I</scope><scope>8AF</scope><scope>8AO</scope><scope>8C1</scope><scope>8C2</scope><scope>8FE</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AEUYN</scope><scope>AFKRA</scope><scope>AN0</scope><scope>ASE</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BEC</scope><scope>BENPR</scope><scope>BHPHI</scope><scope>C1K</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FPQ</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>H94</scope><scope>HCIFZ</scope><scope>K6X</scope><scope>K9-</scope><scope>K9.</scope><scope>KB0</scope><scope>KB~</scope><scope>LK8</scope><scope>M0R</scope><scope>M0S</scope><scope>M0T</scope><scope>M1P</scope><scope>M2M</scope><scope>M2O</scope><scope>M2P</scope><scope>M7N</scope><scope>M7P</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PSYQQ</scope><scope>Q9U</scope><scope>S0X</scope><scope>7X8</scope><scope>7U1</scope><scope>7U2</scope></search><sort><creationdate>20130330</creationdate><title>Cardiac involvement and treatment-related mortality after non-myeloablative haemopoietic stem-cell transplantation with unselected autologous peripheral blood for patients with systemic sclerosis: a retrospective analysis</title><author>Burt, Richard K, Dr ; Oliveira, Maria Carolina, MD ; Shah, Sanjiv J, MD ; Moraes, Daniela A, MD ; Simoes, Belinda, MD ; Gheorghiade, Mihai, MD ; Schroeder, James, MD ; Ruderman, Eric, MD ; Farge, Dominique, MD ; Chai, Z Jessie, BS ; Marjanovic, Zora, MD ; Jain, Sandeep, MD ; Morgan, Amy, NP ; Milanetti, Francesca, MD ; Han, Xiaoqiang, MD ; Jovanovic, Borko, PhD ; Helenowski, Irene B, PhD ; Voltarelli, Julio, MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c594t-b5f389dc4492732d55a309136c5e6c8768f6e9009757d59e2b0788618e3857163</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2013</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</topic><topic>autografting</topic><topic>Biological and medical sciences</topic><topic>Blood</topic><topic>Bone marrow, stem cells transplantation. Graft versus host reaction</topic><topic>Carbon monoxide</topic><topic>cardiac output</topic><topic>Cardiovascular diseases</topic><topic>Cause of Death</topic><topic>Colleges & universities</topic><topic>Compassionate Use Trials</topic><topic>cyclophosphamide</topic><topic>Cytomegalovirus</topic><topic>death</topic><topic>electrocardiography</topic><topic>Epidemiology</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>General aspects</topic><topic>guidelines</topic><topic>heart failure</topic><topic>Heart Failure - mortality</topic><topic>Hematopoietic Stem Cell Transplantation - methods</topic><topic>Hematopoietic Stem Cell Transplantation - mortality</topic><topic>Humans</topic><topic>Hypertension</topic><topic>Internal Medicine</topic><topic>Kaplan-Meier Estimate</topic><topic>lung function</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Mental health</topic><topic>Middle Aged</topic><topic>Mortality</topic><topic>Patients</topic><topic>pericarditis</topic><topic>Pericarditis, Constrictive - mortality</topic><topic>pericardium</topic><topic>Peripheral Blood Stem Cell Transplantation - methods</topic><topic>Peripheral Blood Stem Cell Transplantation - mortality</topic><topic>Public health. Hygiene</topic><topic>Public health. Hygiene-occupational medicine</topic><topic>pulmonary artery</topic><topic>Pulmonary Diffusing Capacity - physiology</topic><topic>Quality of life</topic><topic>Respiratory function</topic><topic>Retrospective Studies</topic><topic>risk</topic><topic>Scleroderma</topic><topic>Scleroderma, Diffuse - mortality</topic><topic>Scleroderma, Diffuse - physiopathology</topic><topic>Scleroderma, Diffuse - therapy</topic><topic>Scleroderma, Limited - mortality</topic><topic>Scleroderma, Limited - physiopathology</topic><topic>Scleroderma, Limited - therapy</topic><topic>sclerosis</topic><topic>screening</topic><topic>Sepsis - mortality</topic><topic>Skin</topic><topic>Stem cells</topic><topic>Survival</topic><topic>Total Lung Capacity</topic><topic>Transfusions. Complications. Transfusion reactions. Cell and gene therapy</topic><topic>Transplantation</topic><topic>Transplantation Conditioning</topic><topic>Transplantation, Autologous</topic><topic>Transplants & implants</topic><topic>Ultrasonic imaging</topic><topic>Veins & arteries</topic><topic>Vital Capacity - physiology</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Burt, Richard K, Dr</creatorcontrib><creatorcontrib>Oliveira, Maria Carolina, MD</creatorcontrib><creatorcontrib>Shah, Sanjiv J, MD</creatorcontrib><creatorcontrib>Moraes, Daniela A, MD</creatorcontrib><creatorcontrib>Simoes, Belinda, MD</creatorcontrib><creatorcontrib>Gheorghiade, Mihai, MD</creatorcontrib><creatorcontrib>Schroeder, James, MD</creatorcontrib><creatorcontrib>Ruderman, Eric, MD</creatorcontrib><creatorcontrib>Farge, Dominique, MD</creatorcontrib><creatorcontrib>Chai, Z Jessie, BS</creatorcontrib><creatorcontrib>Marjanovic, Zora, MD</creatorcontrib><creatorcontrib>Jain, Sandeep, MD</creatorcontrib><creatorcontrib>Morgan, Amy, NP</creatorcontrib><creatorcontrib>Milanetti, Francesca, MD</creatorcontrib><creatorcontrib>Han, Xiaoqiang, MD</creatorcontrib><creatorcontrib>Jovanovic, Borko, PhD</creatorcontrib><creatorcontrib>Helenowski, Irene B, PhD</creatorcontrib><creatorcontrib>Voltarelli, Julio, MD</creatorcontrib><collection>AGRIS</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>News PRO</collection><collection>Pharma and Biotech Premium PRO</collection><collection>Global News & ABI/Inform Professional</collection><collection>ProQuest Central (Corporate)</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>Nursing & Allied Health Database</collection><collection>Neurosciences Abstracts</collection><collection>Toxicology Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Biology Database (Alumni Edition)</collection><collection>Healthcare Administration Database (Alumni)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Psychology Database (Alumni)</collection><collection>Science Database (Alumni Edition)</collection><collection>STEM Database</collection><collection>ProQuest Pharma Collection</collection><collection>Public Health Database</collection><collection>Lancet Titles</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Natural Science Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest One Sustainability</collection><collection>ProQuest Central UK/Ireland</collection><collection>British Nursing Database</collection><collection>British Nursing Index</collection><collection>ProQuest Central Essentials</collection><collection>Biological Science Collection</collection><collection>eLibrary</collection><collection>ProQuest Central</collection><collection>Natural Science Collection</collection><collection>Environmental Sciences and Pollution Management</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>British Nursing Index (BNI) (1985 to Present)</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>SciTech Premium Collection</collection><collection>British Nursing Index</collection><collection>Consumer Health Database (Alumni Edition)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>ProQuest Newsstand Professional</collection><collection>ProQuest Biological Science Collection</collection><collection>Consumer Health Database</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Healthcare Administration Database</collection><collection>Medical Database</collection><collection>ProQuest Psychology</collection><collection>Research Library</collection><collection>Science Database</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Biological Science Database</collection><collection>Research Library (Corporate)</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest One Psychology</collection><collection>ProQuest Central Basic</collection><collection>SIRS Editorial</collection><collection>MEDLINE - Academic</collection><collection>Risk Abstracts</collection><collection>Safety Science and Risk</collection><jtitle>The Lancet (British edition)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Burt, Richard K, Dr</au><au>Oliveira, Maria Carolina, MD</au><au>Shah, Sanjiv J, MD</au><au>Moraes, Daniela A, MD</au><au>Simoes, Belinda, MD</au><au>Gheorghiade, Mihai, MD</au><au>Schroeder, James, MD</au><au>Ruderman, Eric, MD</au><au>Farge, Dominique, MD</au><au>Chai, Z Jessie, BS</au><au>Marjanovic, Zora, MD</au><au>Jain, Sandeep, MD</au><au>Morgan, Amy, NP</au><au>Milanetti, Francesca, MD</au><au>Han, Xiaoqiang, MD</au><au>Jovanovic, Borko, PhD</au><au>Helenowski, Irene B, PhD</au><au>Voltarelli, Julio, MD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Cardiac involvement and treatment-related mortality after non-myeloablative haemopoietic stem-cell transplantation with unselected autologous peripheral blood for patients with systemic sclerosis: a retrospective analysis</atitle><jtitle>The Lancet (British edition)</jtitle><addtitle>Lancet</addtitle><date>2013-03-30</date><risdate>2013</risdate><volume>381</volume><issue>9872</issue><spage>1116</spage><epage>1124</epage><pages>1116-1124</pages><issn>0140-6736</issn><eissn>1474-547X</eissn><coden>LANCAO</coden><abstract>Summary Background Autologous haemopoietic stem-cell transplantation (HSCT) benefits patients with systemic sclerosis but has been associated with significant treatment-related mortality and failure to improve diffusion capacity of carbon monoxide (DLCO). We aimed to assess efficacy of HSCT and use of rigorous cardiac screening in this group. Methods We assessed patients with diffuse systemic sclerosis or limited systemic sclerosis and interstitial lung disease who were treated with HSCT as part of a study or on a compassionate basis at Northwestern University (Chicago, IL, USA) or the University of São Paulo (Ribeirão Preto, Brazil). Unselected peripheral blood stem cells were harvested with cyclophosphamide (2 g/m2 ) and filgrastim. The transplant regimen was a non-myeloablative regimen of cyclophosphamide (200 mg/kg) and rabbit anti-thymocyte globulin (rATG; 4·5–6·5 mg/kg). We followed patients up to 5 years for overall survival, relapse-free survival, modified Rodnan skin score, and pulmonary function tests. Findings Five (6%) of 90 patients died from treatment-related causes. Despite standard guidelines that recommend echocardiogram for screening before transplantation, four treatment-related deaths occurred because of cardiovascular complications (one constrictive pericarditis, two right heart failures without underlying infection, and one heart failure during mobilisation), and one death was secondary to sepsis without documented underlying heart disease. Kaplan-Meier analysis showed survival was 78% at 5 years (after eight relapse-related deaths) and relapse-free survival was 70% at 5 years. Compared with baseline, we noted improvements after HSCT in modified Rodnan skin scores at 1 year (58 patients; p<0·0001), 2 years (42 patients; p<0·0001), and 3 years (27 patients; p<0·0001) and forced vital capacity at 1 year (58 patients; p=0·009), 2 years (40 patients; p=0·02), and 3 years (28 patients; p=0·004), but total lung capacity and DLCO were not improved significantly after HSCT. Overall mean DLCO was significantly improved in patients with normal baseline echocardiograms (p=0·005) or electrocardiographs (p=0·05). Interpretation Autologous HSCT with a non-myeloablative regimen of cyclophosphamide and rATG with a non-selected autograft results in sustained improvement in skin thickness and forced vital capacity. DLCO is affected by baseline cardiac function. Guidelines for cardiac screening of patients with systemic sclerosis to assess treatment-related risk from pulmonary artery hypertension, primary cardiac involvement, or pericardial disease should be reconsidered and updated. Funding None.</abstract><cop>Kidlington</cop><pub>Elsevier Ltd</pub><pmid>23363664</pmid><doi>10.1016/S0140-6736(12)62114-X</doi><tpages>9</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0140-6736 |
| ispartof | The Lancet (British edition), 2013-03, Vol.381 (9872), p.1116-1124 |
| issn | 0140-6736 1474-547X |
| language | eng |
| recordid | cdi_proquest_miscellaneous_1348485810 |
| source | MEDLINE; Elsevier ScienceDirect Journals |
| subjects | Adolescent Adult Aged Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy autografting Biological and medical sciences Blood Bone marrow, stem cells transplantation. Graft versus host reaction Carbon monoxide cardiac output Cardiovascular diseases Cause of Death Colleges & universities Compassionate Use Trials cyclophosphamide Cytomegalovirus death electrocardiography Epidemiology Female Follow-Up Studies General aspects guidelines heart failure Heart Failure - mortality Hematopoietic Stem Cell Transplantation - methods Hematopoietic Stem Cell Transplantation - mortality Humans Hypertension Internal Medicine Kaplan-Meier Estimate lung function Male Medical sciences Mental health Middle Aged Mortality Patients pericarditis Pericarditis, Constrictive - mortality pericardium Peripheral Blood Stem Cell Transplantation - methods Peripheral Blood Stem Cell Transplantation - mortality Public health. Hygiene Public health. Hygiene-occupational medicine pulmonary artery Pulmonary Diffusing Capacity - physiology Quality of life Respiratory function Retrospective Studies risk Scleroderma Scleroderma, Diffuse - mortality Scleroderma, Diffuse - physiopathology Scleroderma, Diffuse - therapy Scleroderma, Limited - mortality Scleroderma, Limited - physiopathology Scleroderma, Limited - therapy sclerosis screening Sepsis - mortality Skin Stem cells Survival Total Lung Capacity Transfusions. Complications. Transfusion reactions. Cell and gene therapy Transplantation Transplantation Conditioning Transplantation, Autologous Transplants & implants Ultrasonic imaging Veins & arteries Vital Capacity - physiology Young Adult |
| title | Cardiac involvement and treatment-related mortality after non-myeloablative haemopoietic stem-cell transplantation with unselected autologous peripheral blood for patients with systemic sclerosis: a retrospective analysis |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-09T06%3A56%3A54IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Cardiac%20involvement%20and%20treatment-related%20mortality%20after%20non-myeloablative%20haemopoietic%20stem-cell%20transplantation%20with%20unselected%20autologous%20peripheral%20blood%20for%20patients%20with%20systemic%20sclerosis:%20a%20retrospective%20analysis&rft.jtitle=The%20Lancet%20(British%20edition)&rft.au=Burt,%20Richard%20K,%20Dr&rft.date=2013-03-30&rft.volume=381&rft.issue=9872&rft.spage=1116&rft.epage=1124&rft.pages=1116-1124&rft.issn=0140-6736&rft.eissn=1474-547X&rft.coden=LANCAO&rft_id=info:doi/10.1016/S0140-6736(12)62114-X&rft_dat=%3Cproquest_cross%3E1322730009%3C/proquest_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=1321459731&rft_id=info:pmid/23363664&rft_els_id=S014067361262114X&rfr_iscdi=true |