Abstract
Introduction. The natriuretic peptides are neurohormones that act to relieve the symptoms associated with volume expansion and pressure overload by promoting natriuresis and diuresis, vasodilatation, and suppression of the Renin Angiotensin Aldosterone system. Serum N-terminal prohormone of brain natriuretic peptide (NT-proBN) levels in the blood have been used for screening and diagnosis of congestive heart failure (CHF) in cardiology practice. However, there is no data to support the predictive value of its levels in patients with malignant lymphomas (ML) during the high-dose chemotherapy (HDC) with autologous hematopoietic stem cells transplantation (auto-HSCT).
The goal of the study was to evaluate the cardiotoxic effect of HDC with auto-HSCT in patients with malignant lymphomas using NT-proBN at different time before and after the treatment; to evaluate dependence of increasing levels of this biochemical marker with age and different conditioning regimen.
Material and metods. The study included 127 patients (67 - Hodgkin's lymphoma, 28 - non-Hodgkin's lymphomas, and 32 - multiple myeloma) The median age was 37 year (range: 19 to 68 years); 80 females, 47 males. The level of NT-proBNP was monitored before starting the HDC (point1), after the HDC (point 2), and on day 12 after the auto-HSCT (point 3).
Results; Levels of NT-proBNP at time of admission to the hospital (point 1) was significantly lower than at the end of the HDC (point 2) and on D + 12 (point 3).
There were no significant correlations between the age of patients and the level of NT-proBNP before HDC (point 1) and level on D + 12 (point 3); however, in point 2, after HDC, a significant positive Spearmen correlation coefficient, R = 0.20, was obtained. So the older the patient, the higher the probability of an increase in the concentration of NT-proBNP after HDC.
Analysis of the dependence of changes in the level of NT-proBNP on the sex of patients at different periods of the study revealed significant differences in marker levels in men and women, in women its concentration is higher than in men before HDC (poin 1). After completion of conditioning and on day 12, the level of NT-proBNP in women still significantly exceeded the corresponding value in men.
Analisis of the level of the marker, depending on different conditioning regimens, showed that before the start of conditioning there were no significant differences in marker levels in patients who received the CBV regimen and high doses of melphalan. After the end of conditioning, a significant increase in the concentration of the marker was established in patients undergoing CBV, the median of NT-proBNP concentration was 526 pg/ml, whereas the patients receiving melphalan received 245 pg/ml. However, in point 3 the revealed differences were leveled off.
Comparison of the concentrations of NT-proBNP in the groups of patients receiving BEAM and melphalan did not reveal significant differences. At the same time, the assessment of the marker levels at the poin after HDC showed significant differences. Median NT-proBNP concentrations in this period were 152.9 pg/ml in patients treated with BEAM, 293 pg/ml in patients treated with CBV (Figure 1)
The results of the analysis of the relationship between the level of NT-proBNP and the total dose of cyclophosphamide showed the presence of a moderate significant correlation of the cyclophosphamide dose and the concentration of the marker in at the end of HDC (point 2), R = 0.40 (Table 1). At the same time, an assessment of the relationship between the level of NT-proBNP and the total dose of etoposide did not reveal the presence of significant correlation coefficients at all times of the study.
Conclusion: The results obtained can serve as a basis for considering NT-proBNP as a marker of cardiotoxicity of HDC and auto-HSCT.
No relevant conflicts of interest to declare.
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