成人病患經異體造血幹細胞移植後產生心包膜積液之風險及處理

10.6666/ClinMed.2017.80.1.076

劉耀中；高志平；劉嘉仁；蕭樑材；劉俊煌

幹細胞移植(stem cell transplantation) ； 心包膜積液(pericardial effusion, PE) ； 心包填塞(cardiac tamponade) ； 移植物抗宿主疾病(graft-versus-host disease, GVHD)

臨床醫學月刊

80卷1期（2017 / 07 / 28）

403 - 408

繁體中文

對於血液相關疾病，在接受異體造血幹細胞移植(allogeneic hematopoietic stem cell transplantation, Allo-HSCT)治療後的病患中，心包膜積液(pericardial effusion, PE)是一種罕見且可能危及生命的併發症之一。其危險因子、病因、發病率和治療在臨床上仍有許多不明。為了詳細了解這個問題及發生率，我們回顧了2003年1月至2013年12月之間391例Allo-HSCT病患。12位(3.1%)病患出現中等至大量的PE，其中高達9位(75%)是遲發性(late-onset) PE，而其中2位遲發性案例經治療後再度復發。這12例病患平均中位年齡為44.5歲(範圍：22到63歲)；9位遲發性PE案例平均中位年齡為47歲。在多變數統計分析下，接受多次HSCT對於發生PE是有意義的危險因素(p = 0.036)，病患年齡大於50歲會有產生PE的趨勢(p = 0.066)。針對遲發性PE病患統計後，其風險因素包括：移植前年齡大於50歲(p = 0.032)以及廣泛的慢性移植物抗宿主病(chronic graft-versus-host disease, cGVHD)(p = 0.006)。目前仍無其他文獻探討Allo-HSCT後發生PE的相關危險因子，而本文是第一篇確定移植後PE的發生率與風險因子的研究。

1. Aldoss, O,Gruenstein, DH,Bass, JL(2013).Pericardial effusion after pediatric hematopoietic cell transplant.Pediatric Transplant,17,294-299.
2. Angelucci, E,Mariotti, E,Lucarelli, G(1992).Sudden cardiac tamponade after chemotherapy for marrow transplantation in thalassaemia.Lancet,339,287-289.
3. Filipovich, AH,Weisdorf, D,Pavletic, S(2005).National Institutes of Health consensus development project on criteria for clinical trials in chronic graft-versus-host disease: I. Diagnosis and staging working group report.Biology of Blood and Marrow Transplant,11,945-956.
4. Hertenstein, B,Stefanic, M,Schmeiser, T(1994).Cardiac toxicity of bone marrow transplantation: predictive value of cardiologic evaluation before transplant.Journal of Clinical Oncology,12,998-1004.
5. Liu, YC,Chien, SH,Fan, NW(2015).Risk factors for pericardial effusion in adult patients receiving allogeneic haematopoietic stem cell transplantation.Br J Haematol,169,737-745.
6. Liu, YC,Gau, JP,Hong, YC(2012).Large pericardial effusion as a life-threatening complication after hematopoietic stem cell transplantation-association with chronic GVHD in late-onset adult patients.Annals of Hematology,91,1953-1958.
7. Murdych, T,Weisdorf, DJ(2001).Serious cardiac complications during bone marrow transplantation at the University of Minnesota, 1977-1997.Bone Marrow Transplant,28,283-287.
8. Norkin, M,Ratanatharathorn, V,Ayash, L(2011).Large pericardial effusion as a complication in adults undergoing SCT.Bone Marrow Transplant,46,1353-1356.
9. Rhodes, M,Lautz, T,Kavanaugh-Mchugh, A(2005).Pericardial effusion and cardiac tamponade in pediatric stem cell transplant recipients.Bone Marrow Transplant,36,139-144.
10. Silberstein, L,Davies, A,Kelsey, S(2001).Myositis, polyserositis with a large pericardial effusion and constrictive pericarditis as manifestations of chronic graft-versus-host disease after non-myeloablative peripheral stem cell transplantation and subsequent donor lymphocyte infusion.Bone Marrow Transplant,27,231-233.
11. Steinherz, LJ,Steinherz, PG,Mangiacasale, D(1981).Cardiac changes with cyclophosphamide.Medical and Pediatric Oncology,9,417-422.
12. Thomas, ED,Storb, R,Clift, RA(1975).Bone-marrow Transplant.New England Journal of Medicine,292,895-902.
13. Von Hoff, DD,Rozencweig, M,Layard, M(1977).Daunomycin-induced cardiotoxicity in children and adults. A review of 110 cases.American Journal of Medicine,62,200-208.