Large pericardial effusion as a life-threatening complication after hematopoietic stem cell transplantation-association with chronic GVHD in late-onset adult patients

Large pericardial effusion (LPE) with cardiac tamponade is a rare but life-threatening complication in adults undergoing hematopoietic stem cell transplantation (HSCT). The incidence and pathophysiology have not been well defined. We retrospectively reviewed 601 patients (?18 years of age) receiving HSCT (262 autologous, 189 siblings, and 150 unrelated donors) in our center from January 2001 to September 2011. We described the incidence, clinical characteristics, treatment, and outcome. In total, six patients (0.998 %) developed seven episodes (1.16 %) of LPEs with cardiac tamponade. One patient underwent unrelated allografts and the other five patients received sibling allografts. The median day of detecting LPE were 176 in the six patients and 241 in the four late-onset patients (range, 9-369). All patients had normal cardiac function before HSCT. Two patients developed LPE early after conditioning, considered as cardiac toxicity resulting from high-dose cyclophosphamide. Four patients had chronic graft-versus-host disease (GVHD) involving lung, skin and sicca syndrome concomitant with or preceding the development of LPE. All episodes of cardiac tamponade were effectively managed by pericardiocentesis and enhanced immunosuppression. In conclusion, LPE and cardiac tamponade may develop after allogeneic HSCT, either with sibling or matched unrelated donor. The etiology is probably related to chronic GVHD in cases of late onset. Emergent pericardiocentesis and enhanced immunosuppression can effectively control this life-threatening complication.