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Clinical features and outcomes of patients admitted to the ICU for Cyclophosphamide-associated cardiac toxicity: a retrospective cohort

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Abstract

Purpose

To describe the management and outcome of critically-ill patients with Cyclophosphamide (CY)-associated cardiac toxicity.

Methods

All patients admitted to the intensive care units (ICUs) of the Nantes and Rennes University Hospitals for a CY-associated cardiac toxicity between January 2015 and December 2020 were included.

Results

Of the thirty-four patients included in the study, twenty-four (70%) underwent allogeneic hematopoietic stem cell transplantation (HSCT), four (12%) autologous HSCT, and six (18%) chemotherapy for hematological malignancies. Acute pulmonary edema (65%), cardiac arrest (9%), and cardiac arrhythmia (6%) were the most common reasons for ICU admission. Patients were admitted to the ICU 6.5 (4-12) days after the intravenous administration of a median dose of CY of 100 [60-101] mg/Kg. Echocardiographic findings showed moderate to severe left ventricular systolic dysfunction (69%) and pericardial effusion (52%). Eighteen (53%) patients ultimately developed cardiogenic shock and required vasopressors (47%) and/or inotropes (18%). Invasive mechanical ventilation and renal replacement therapy were required in twenty (59%) and five (14%) patients, respectively. Sixteen (47%) patients died of whom 12 (35.3%) died from refractory cardiogenic shock. The left ventricular ejection fraction improved over time in most survivors with a median time until full recovery of 33 (12-62) days. Two (11%) patients had a persistent left ventricular dysfunction at 6 months.

Conclusion

Refractory cardiogenic shock is the primary cause of death of patients with severe CY-related cardiotoxicity. Nonetheless, the cardiac function of most survivors recovered within a month.

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Acknowledgments

We thank Julien Cadiet for helping in data collection.

Financial support

None.

Funding

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

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Authors and Affiliations

  1. Nantes Universté, CHU Nantes, Médecine Intensive Réanimation, F-44000, Nantes, France

    Alice Vennier, Emmanuel Canet, Amélie Seguin, Jean Reignier, Jean-Baptiste Lascarrou & Jérémie Emarié

  2. Nantes Université, CHU Nantes, Pôle Hospitalo-Universitaire 11: Santé Publique, Clinique des données, INSERM, CIC 1413, F-44000, Nantes, France

    Vianney Guardiolle

  3. Service de Médecine Intensive Réanimation, CHU de Rennes, Rennes, France

    Florian Reizine & Jean-Marc Tadié

  4. Nantes Université, CHU Nantes, CNRS, INSERM, l’institut du thorax, F-44000, Nantes, France

    Jean-Noël Trochu & Thierry Le Tourneau

  5. Service d’Hématologie, CHU de Nantes, Nantes Université, Nantes, France

    Cyrille Touzeau

  6. Service d’Hématologie Clinique, CHU de Rennes, Université de Rennes, INSERM U1236, Rennes, France

    Roch Houot

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  1. Alice Vennier
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Contributions

AV was the principal investigator and takes primary responsibility for the paper. JMT, TLT, JNT, CT, FR, RH, AS, JR, JBL, recruited the patients. AV, VG and JL did the statistical analysis. AV, JL and EC co-ordinated the research and wrote the manuscript.

Corresponding author

Correspondence to Emmanuel Canet.

Ethics declarations

Ethics approval

This study was approved by the ethics committee of the French Intensive Care Society (CE SRLF 22-058) on December 18, 2022.

Consent to participate

In accordance with French law on retrospective studies of anonymized healthcare data, informed consent was not required.

Competing interests

EC has received lecturer and conference-speaker fees, as well as reimbursements of travel and accommodation expenses related to attending scientific meetings, from Gilead, Shionogi, and Sanofi-Genzyme. JBL has received lecturer and conference-speaker fees from BD and Zoll. RH reports honoraria from Kite/Gilead, Novartis, Incyte, Janssen, MSD, Takeda and Roche; and consultancy at Kite/Gilead, Novartis, Bristol-Myers Squibb/Celgene, ADC Therapeutics, Incyte, Miltenyi. None of the other authors have relevant financial or non-financial interests to disclose.

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Vennier, A., Canet, E., Guardiolle, V. et al. Clinical features and outcomes of patients admitted to the ICU for Cyclophosphamide-associated cardiac toxicity: a retrospective cohort. Support Care Cancer 31, 474 (2023). https://doi.org/10.1007/s00520-023-07951-9

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