Review on the Development of Pericardial Effusion after Hematopoietic Stem Cell Transplantation

To provide the reader with an overview of risk factors, diagnosis, and management of pericardial effusion (PEff) after hematopoietic stem cell transplant (HSCT).

HSCT replaces dysfunctional bone marrow with healthy stem cells to treat various conditions including metabolic disorders and hematologic malignancies. Short-term complications of HSCT include the development of PEff. Recent studies have identified graft-versus-host disease, transplant-associated thrombotic microangiopathy, type of conditioning regimen, hematopoietic stem cell source, and infection as risk factors for the development of PEff following HSCT.

Guidelines for echocardiographic surveillance of PEffs in patients undergoing chemotherapy and advanced cellular therapies are not well defined, with monitoring largely based on symptoms and effusion size. Small effusions (< 10 mm) often need no further follow-up; while moderate to large effusions may progress to cardiac tamponade warranting echocardiograms at 1 to 2 weeks, 1 month, and 6 months after diagnosis pending hemodynamic status. Recent European Society Guidelines suggest re-evaluating small to medium-sized effusions 7 to 14 days after diagnosis and then every 4 to 6 weeks thereafter; though further research is needed on the cost-effectiveness of prolonged monitoring.