Orthotopic heart transplantation for hematopoietic stem cell transplantation related end-stage heart failure in pediatric acute monocytic leukemia: a case report

Abstract

Acute monocytic leukemia (AML-M5) is a distinct subtype of acute myeloid leukemia. Hematopoietic stem cell transplantation (HSCT) is a curative treatment option for AML but is associated with various cardiovascular complications. Long-term heart failure after pediatric HSCT is an uncommon cardiovascular complication, with reported incidence rates below 1%. We present a challenging case of end-stage heart failure developing during long-term follow-up after HSCT that was successfully managed with orthotopic heart transplantation. A 15-year-old patient with AML-M5 developed progressive cardiac dysfunction during long-term follow-up after HSCT and ultimately progressed to end-stage heart failure despite guideline-directed medical therapy. Pre-transplantation cardiac function had previously been normal. The patient underwent successful orthotopic heart transplantation. Post-transplantation course was uneventful, and follow-up assessments demonstrated satisfactory graft function with normal ventricular geometry. Histopathological examination of the explanted heart demonstrated pathological changes consistent with advanced dilated cardiomyopathy. This case highlights the potential for late-onset, progressive heart failure in long-term HSCT survivors. For selected patients with GDMT-refractory end-stage heart failure, orthotopic heart transplantation represents a feasible therapeutic option. Long-term cardiovascular surveillance is essential to facilitate early detection and management of progressive cardiac dysfunction in HSCT recipients.