Extracorporeal membrane oxygenation (ECMO) during aplasia: A bridge towards myopericarditis recovery after autologous hematopoietic stem cell transplant for systemic sclerosis and recent Coronarovirus disease (COVID-19) vaccination.

Autor: Cacciatore C; Unité de Médecine Interne (UF04): CRMR MATHEC, Maladies Auto-immunes et Thérapie Cellulaire, Centre de Référence des Maladies auto-immunes systémiques Rares d'Ile-de-France, AP-HP, Hôpital St-Louis, F-75010 Paris, France; Université Paris Cité, IRSL, Recherche Clinique en hématologie, immunologie et transplantation, URP3518, F-75010 Paris, France., Baudet M; Department of Cardiology, Hospital Saint-Louis, Paris, France., Jean E; Département de Médecine Interne, Hôpital de la Timone, Assistance Publique des Hôpitaux de Marseille, Marseille, France; Centre de référence des syndromes drépanocytaires majeurs, thalassémies et autres pathologies rares du globule rouge et de l'érythropoïèse, Assistance Publique des hôpitaux de Marseille, 264, rue Saint-Pierre, 13005 Marseille, France., Presente S; Medical and Infectious Diseases ICU, APHP, Bichat Hospital, Paris, France., Para M; Department of Cardiovascular Surgery and Transplantation, Bichat Hospital, AP-HP, Paris, France; Laboratory of Vascular Translational Science, University of Paris-Cité, UMR 1148 Paris, France., Sonneville R; Department of Cardiovascular Surgery and Transplantation, Bichat Hospital, AP-HP, Paris, France; Laboratory of Vascular Translational Science, University of Paris-Cité, UMR 1148 Paris, France., Arangalage D; Cardiology Department, AP-HP, Bichat Hospital and Université de Paris-Cité, Paris, France., Ait Abdallah N; Service de Médecine Interne 2, maladies auto-immunes et systémiques, AP-HP, Hôpital Pitié-Salpêtrière, Paris, France., Sicre de Fontbrune F; Hematology and Transplantation Department, Saint Louis Hospital, Paris, France., Prata PH; Hematology and Transplantation Department, Saint Louis Hospital, Paris, France., Crichi B; Unité de Médecine interne (UF07), AP-HP, Hôpital St-Louis, F-75010 Paris, France., Hervier B; Unité de Médecine interne (UF07), AP-HP, Hôpital St-Louis, F-75010 Paris, France., Parquet N; Unité d'Aphérèse Thérapeutique, Hôpital Saint-Louis, AP-HP, Paris, France., Soulat G; Radiologie, Hôpital Européen Georges Pompidou, APHP, INSERM 970, Université de Paris-Cité, France., Mousseaux E; Radiologie, Hôpital Européen Georges Pompidou, APHP, INSERM 970, Université de Paris-Cité, France., Burt RK; Scripps Health, La Jolla USA,; Genani Corporation, Chicago, USA., Farge D; Unité de Médecine Interne (UF04): CRMR MATHEC, Maladies Auto-immunes et Thérapie Cellulaire, Centre de Référence des Maladies auto-immunes systémiques Rares d'Ile-de-France, AP-HP, Hôpital St-Louis, F-75010 Paris, France; Université Paris Cité, IRSL, Recherche Clinique en hématologie, immunologie et transplantation, URP3518, F-75010 Paris, France; Department of Medicine, McGill University, H3A 1A1, Montreal, Canada. Electronic address: dominique.farge-bancel@aphp.fr.
Jazyk: angličtina
Zdroj: Current research in translational medicine [Curr Res Transl Med] 2024 Sep; Vol. 72 (3), pp. 103449. Date of Electronic Publication: 2024 Apr 09.
DOI: 10.1016/j.retram.2024.103449
Abstrakt: Systemic sclerosis (SSc) is a rare autoimmune disease (AD), characterised by early diffuse vasculopathy, activation of the immune response and progressive skin and internal organ fibrosis. In severe progressive diffuse SSc (dSSc), autologous hematopoietic stem cell transplantation (aHSCT) improves survival, despite its own risk of complications and transplant related mortality (TRM). We present herein the case of a dSSc patient undergoing aHSCT with low dose cyclophosphamide conditioning and sudden acute myopericarditis and cardiogenic shock, four weeks after a second mRNA SARS-CoV-2 vaccine (Pfizer) injection. Four days of extracorporeal membrane oxygenation (ECMO) support during the aplasia period, allowed to observe full cardiac function recovery and progressive SSc rehabilitation with sustained disease response at 30 months follow-up. This report illustrates, for the first time to our knowledge, that ECMO can be indicated despite aplasia during aHSCT and successfully used as a bridge towards heart function recovery in highly selected and fragile AD patients. We review the factors that may contribute to endothelial and myocardial stunning and acute reversible cardiac failure in SSc and aggravate intrinsic endothelial injury during the aHSCT procedure. These classically include: cyclophosphamide drug toxicity, viral infections and autoimmune activation with disease flair per se. In the COVID-19 pandemic times, acute myocarditis due to recent viral infection or mRNA vaccine per se, must also be considered.
(Copyright © 2024. Published by Elsevier Masson SAS.)
Databáze: MEDLINE
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