Stem cell therapy for congestive heart failure
A 58-year-old male with relapsed HL was referred to our bone marrow transplantation unit in October 2009. He was given 8 courses of combination chemotherapy with doxorubicin, bleomycin, vincristine, and dacarbazine (ABVD) between June 2008 and February 2009 and achieved complete remission. However, his disease relapsed 3 months after completing the last cycle of ABVD and he was decided to be treated with DHAP (cisplatin, cytarabine, dexamethasone) followed autologous stem cell transplantation (SCT). After the completion of first course of DHAP regimen, he developed acute myocardial infarction (AMI) and coronary artery bypass grafting (CABG) was performed. After his cardiac function stabilized, 3 additional courses of DHAP were given and he was referred to our centre for consideration of autologous SCT. Computed tomography scans obtained after chemotherapy confirmed complete remission. Stem cells were collected from peripheral blood after mobilization with 10 µg/kg/day granulocyte colony-stimulating factor (G-CSF) subcutaneously. Collection was started on the fifth day of G-CSF and performed for 3 consecutive days. Flow cytometric analysis of CD 34 was used to identify hematopoietic stem cells. During the last evaluation before stem cell transplantation, conventional echocardiogram (ECHO) revealed left ventricular systolic dysfunction with an ejection fraction of ALEF: 44%, MODEF: 45%, MUGA scan showed a decreased left ventricular ejection fraction (LVEF: 43%) ().\nIn view of these findings, the patient was found ineligible for SCT and he was offered to give his peripheral blood stem cells for the treatment of heart failure. After receiving the patient’s signed informed consent form, a total number of 3.49x106/kg CD 34+ cells were infused via antecubital vein. Echocardiographic studies performed 2 months after stem cell therapy revealed a similar ejection fraction rate while a significant improvement in left ventricular ejection fraction (ALEF: 55%, MODEF: 57%) was noticed in ECHO performed 7 months after stem cell therapy ().\nEF values at various time periods are shown on . Myocardial perfusion scintigraphy was also performed and showed infarction containing viable tissue in inferior wall (). Myocardial positron emission tomography revealed that glucose metabolism was conserved in inferior wall.\nHL was in complete remission in the 2 months follow up after SCT but SCT for HL was not contemplated because renal failure due to chemotherapy developed later.