Acute Heart GVHD Requires Early Management and High Suspicion

Acute graft-versus-host disease (GVHD) is a frequent complication following allogeneic hematopoietic cell transplantation (HCT), marked by organ damage and inflammation. Acute cardiac GVHD is a rare but life-threatening occurrence.

In an abstract presented at the 11^th Annual Meeting of the Society of Hematologic Oncology (SOHO), Houston, Texas, Burcu Aslan Candir, MD, Department of Hematology and Bone Marrow Transplantation Center, University of Health Sciences, Ankara, Turkey, presented the case of a 30-year-old man diagnosed with B-cell acute lymphoblastic leukemia who underwent haploidentical HCT upon achieving complete remission.

Thirty-three days post-HCT, the patient presented with chest pain, breathing difficulties, acute heart failure, renal failure, pleural effusions, and watery diarrhea. The diagnosis was acute heart and renal GVHD.

Given abnormal coagulation tests and the patient’s unsuitable clinical condition for kidney or heart biopsy, a 5-day pulse of 1000 mg/day prednisolone was administered, along with hemodialysis, ultrafiltration, and dobutamine.

The patient’s renal function improved, and he no longer required hemodialysis. His heart rate, arterial tension, and pleural effusion normalized. After 1 month, the patient’s heart function had improved to an ejection fraction of 50%. The patient still had septal hypokinesia, but his other cardiac walls were normal.

Dr. Candir and the team concluded, “Early management is critical in patients with acute heart GVHD who are not eligible for biopsy at the time of presentation. If there is a high index of suspicion, immediate pulse steroid administration should be considered without waiting for biopsy.”

Reference

Candir BA, Yaman S, Bozan E, et al. Acute Graft-Versus-Host Disease (GVHD) of the Heart Is an Emergency. Abstract CT-089. Presented at the 11th Annual Meeting of the Society of Hematologic Oncology; September 6-9, 2023; Houston, Texas.