Pericarditis in chronic graft-versus-host disease

Pericardial effusion (PE) can be associated with chronic graft-versus-host disease (cGvHD) but the pathophysiology of the disease has not yet been extensively studied. To date, there is a lack of data on the risk and incidence of the condition. Ewa Karakulska-Prystupiuk from Medical University of Warsaw, Warsaw, Poland, and colleagues aimed to evaluate the incidence and risk factors of exudative pericarditis in patients with cGvHD. The results of the study were published in Transplantation Proceedings.

N = 105 patients who underwent allogenic hematopoietic stem cell transplantation (allo-HSCT) between 2010 and 2016 were included and analyzed retrospectively. Of them, 50 patients had cGvHD. Electrocardiography, echocardiography, N-terminal prohormone of brain natriuretic peptide (NT-proBNP) parameters were used.

Key findings:

• Incidence of pericarditis: 6 patients
• Endocrine disorders were observed in four patients
  • Compensated hypothyroidism: 2 patients
  • Hyperprolactinemia: 1 patient
  • Iatrogenic ovarian insufficiency: 3 patients
• Iron overload was found in all patients
• Elevated NT-proBNP and signs of NYHA heart insufficiency grade II or III was found in all patients
• Only minor fluctuations were found in electrocardiogram
• One patient’s symptoms improved after glucocorticosteroid monotherapy, whereas other patients had to receive additional therapies such as tacrolimus plus sirolimus, rituximab, and extracorporeal photopheresis

Taken together, the authors stated that pericarditis may be observed up to 5% of allo-HSCT recipients, mainly in patients with moderate and severe chronic GvHD. Furthermore, GvHD related pericarditis can be treated with escalated dose of immunosuppressants resulting in favorable outcomes. The authors added that “early diagnosis may be achieved by systematic NT-proBNP testing and periodic echocardiogram evaluation. Further studies are needed to better understand the role of cytotoxic lymphocytes in the pathophysiology and diagnosis of PE.”

References

1. Karakulska-Prystupiuk E. et al. Pericarditis in Patients With Chronic Graft-vs-Host Disease. Transplant Proc. 2018 Sep;50(7):2218-2222. DOI: 1016/j.transproceed.2018.02.130. Epub 2018 Mar 14.