A fluid relationship: Calcineurin inhibitors and pericardial effusions

BackgroundHematopoietic stem cell transplantation (HSCT) is a common and effective treatment for multiple malignant and non-malignant pediatric conditions. Graft-versus-host disease (GVHD) is a common complication of HSCT that can be prevented with prophylactic use of calcineurin inhibitor (CNI) immunosuppressants. A complication of HSCT and CNI use is pericardial effusion (PEF), which is frequently treated by CNI discontinuation with or without surgical intervention. No studies to date have evaluated the management of PEF without CNI discontinuation as a means of preventing GVHD flares.MethodsIn this single-center retrospective study, we reviewed the management of PEF in pediatric patients post-HSCT who received conservative or surgical intervention with or without CNI discontinuation between May 2012 and June 2022.ResultsOf the patients found to have PEF, all were given tacrolimus for GVHD prophylaxis. Management of PEF included surgical intervention for 83% of patients, and CNI was not discontinued for 83%. None of the patients developed GVHD during the management of PEF.ConclusionsOur results demonstrate that continuation of CNI therapy for GVHD prophylaxis did not negatively impact the disease course of PEF in post-HSCT patients.

Automated summary

This study retrospectively evaluated the management of pericardial effusion (PEF) in pediatric patients post-HSCT. The results showed that continuing calcineurin inhibitor (CNI) therapy for graft-versus-host disease (GVHD) prophylaxis did not have a negative impact on the disease course of PEF.