Original Article

Successful treatment of massive pericardial effusion after hematopoietic stem cell transplantation with tocilizumab: two cases report

  • Yue LI ,
  • Xiaohui ZHOU ,
  • Xiaodong WANG ,
  • Chunlan YANG ,
  • Chunjing WANG ,
  • Yu ZHANG ,
  • Sixi LIU
Expand
  • Department of Hematology and Oncology, Shenzhen Children’s Hospital, Shenzhen 518000, Guangdong, China

Received date: 2023-09-02

  Online published: 2024-07-08

Abstract

To explore the efficacy and safety of interleukin-6 receptor monoclonal antibody (tocilizumab) in patients with glucocorticoid-resistant/recurrent massive pericardial effusion after hematopoietic stem cell transplantation. The clinical data, diagnosis, treatments, and outcomes of 2 children with β-thalassemia major complicated by massive pericardial effusion after hematopoietic stem cell transplantation were analyzed retrospectively. One case of pericardial effusion was glucocorticoid-resistant and 1 case was recurrent. The pericardial effusion was resolved rapidly after administration of tocilizumab without significant adverse effects, the course of glucocorticoid therapy was shortened, and there was no recurrence of pericardial effusions during subsequent follow-up. Tocilizumab may be considered as a second-line option for patients with glucocorticoid-resistant or recurrent massive pericardial effusion after hematopoietic stem cell transplantation.

Cite this article

Yue LI , Xiaohui ZHOU , Xiaodong WANG , Chunlan YANG , Chunjing WANG , Yu ZHANG , Sixi LIU . Successful treatment of massive pericardial effusion after hematopoietic stem cell transplantation with tocilizumab: two cases report[J]. Journal of Clinical Pediatrics, 2024 , 42(7) : 595 -599 . DOI: 10.12372/jcp.2024.23e0861

References

[1] Aldoss O, Gruenstein DH, Bass JL, et al. Pericardial effusion after pediatric hematopoietic cell transplant[J]. Pediatr Transplant, 2013, 17(3): 294-299.
[2] Hamada S, Miyamoto J, Oshiro T, et al. Possible involvement of IL-6-producing tissue-resident macrophages in early-onset pericardial effusion pathogenesis after hematopoietic stem cell transplantation[J]. Pediatr Blood Cancer, 2018, 65(6): e26982.
[3] Liu YC, Gau JP, Hong YC, et al. Large pericardial effusion as a life-threatening complication after hematopoietic stem cell transplantation-association with chronic GVHD in late-onset adult patients[J]. Ann Hematol, 2012, 91(12): 1953-1958.
[4] Liu YC, Chien SH, Fan NW, et al. Risk factors for pericardial effusion in adult patients receiving allogeneic haematopoietic stem cell transplantation[J]. Br J Haematol, 2015, 169(5): 737-745.
[5] Yang CL, Wang XD, Zhou XH, et al. Clinical characteristics and risk factors of pericardial effusion after hematopoietic stem cell transplantation in children with thalassemia major[J]. Zhonghua Er Ke Za Zhi, 2022, 60(4): 323-328.
[6] Versluys AB, Grotenhuis HB, Boelens MJJ, et al. Predictors and outcome of pericardial effusion after hematopoietic stem cell transplantation in children[J]. Pediatr Cardiol, 2018, 39(2): 236-244.
[7] Diamond M, Ruiz-Mesa C, Corrales-Medina FF, et al. Incidence and outcome of pericardial effusion in pediatric patients after hematopoietic stem cell transplant: a single-institution experience[J]. J Pediatr Hematol Oncol, 2018, 40(2): 132-136.
[8] Matin A, Smith BH, Mangaonkar A, et al. Pericardial effusion as a purported manifestation of graft versus host disease following allogeneic hematopoietic cell transplantation[J]. Transplant Cell Ther, 2023, 29(5):324.
[9] Leong K, Heal ME, Bass JL, et al. Effects of systemic steroid administration on recurrence of pericardial effusion in pediatric patients after hematopoietic stem cell transplantation[J]. J Pediatr Hematol Oncol, 2020, 42(4): 256-260.
[10] Imazio M. Noninfectious pericarditis: management challenges for cardiologists[J]. Kardiol Pol, 2020, 78(5): 396-403.
[11] Terkeltaub RA, Furst DE, Digiacinto JL, et al. Novel evidence-based colchicine dose-reduction algorithm to predict and prevent colchicine toxicity in the presence of cytochrome P450 3A4/P-glycoprotein inhibitors[J]. Arthritis Rheum, 2011, 63(8): 2226-2237.
[12] Hindricks G, Potpara T, Dagres N, et al. Corrigendum to: 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): The Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC[J]. Eur Heart J, 2021, 42(40): 4194.
[13] Ozaki Y, Tanaka A, Shimamoto K, et al. A case of rheumatoid pericarditis associated with a high IL-6 titer in the pericardial fluid and tocilizumab treatment[J]. Mod Rheumatol, 2011, 21(3): 302-304.
[14] De Matteis A, Sacco E, Celani C, et al. Tocilizumab for massive refractory pleural effusion in an adolescent with systemic lupus erythematosus[J]. Pediatr Rheumatol Online J, 2021, 19(1): 144.
[15] Cao Y, Liu Y, Zhang R, et al. Cardiac involvement in a patient with B-cell lymphoblastic lymphoma/acute lymphoblastic leukemia and a history of allogeneic hematopoietic stem cell transplantation and CAR T-cell therapy: A case report[J]. Front Immunol, 2022, 13: 1052336.
[16] Pinto AR, Godwin JW, Chandran A, et al. Age-related changes in tissue macrophages precede cardiac functional impairment[J]. Aging (Albany NY), 2014, 6(5): 399-413.
[17] van de Garde MD, Martinez FO, Melgert BN, et al. Chronic exposure to glucocorticoids shapes gene expression and modulates innate and adaptive activation pathways in macrophages with distinct changes in leukocyte attraction[J]. J Immunol, 2014, 192(3): 1196-1208.
Outlines

/