@article{oai:ir.kagoshima-u.ac.jp:00014460,
 author = {NAKAE, Koji and UENO, Kentaro and KAWAMURA, Junpei and YANAGIMOTO, Kosuke and EGUCHI, Taisuke and NOMURA, Yuichi and KAKIHANA, Yasuyuki and KAWANO, Yoshifumi},
 issue = {1-3},
 journal = {鹿児島大学医学雑誌, Medical journal of Kagoshima University},
 month = {Dec},
 note = {Cyclophosphamide is one of the most widely used antineoplastic drugs. It is also a potent immunosuppressive agent administered to patients undergoing bone marrow transplantation (BMT). Here we report two cases of aplastic anemia in which severe cardiac dysfunction followed the serial administration of cyclophosphamide (50 mg/m² for 4 days). Both patients gradually developed dyspnea and showed oliguria 3–4 days after BMT. Cardiomegaly was seen on chest X-ray. Echocardiography showed reduced left ventricular contraction, pericardial effusion, and myocardial thickening. Cyclophosphamide-induced cardiotoxicity was suspected and the patients were treated accordingly but were refractory to pharmacotherapy. They were transferred to the intensive care unit where they received mechanical cardiopulmonary support, which improved left ventricular cardiac performance and led to a regression of myocardial thickening. Although both patients died because of severe pulmonary and renal complications, the rapid initiation of mechanical cardiopulmonary support may be a useful strategy in patients with a deteriorating condition, by allowing cardiac recuperation and therefore gaining time for further, potentially life-saving treatment., シクロフォスファミドは抗腫瘍薬として、また骨髄移植の前処置時に免疫抑制薬としても広く使用されている。われわれは、シクロフォスファミド投与後（50mg/m2 4 日間）に重症心筋障害をきたした再生不良性貧血の2 症例を経験した。両患者ともに移植後3-4 日で呼吸困難、乏尿がみられ、胸部エックス線で心拡大、心エコー検査で左室収縮能の低下、心嚢液貯留および心筋肥厚所見を認めた。シクロフォスファミドによる重症心筋障害から循環不全をきたしたと考え、循環作動薬で加療したが改善せず、集中治療室で経皮的心肺補助装置、大動脈内バルーンパンピングを用いた補助循環装置を導入した。補助循環装置での治療開始後、心収縮力は改善し、心筋肥厚も軽快した。両患者ともに補助循環装置から離脱することができたが、重篤な移植後合併症で死亡した。シクロフォスファミドによる重症心筋障害はまれに発生するが、早期の診断ならびに補助循環装置を用いた集中治療管理を行うことで心筋の回復が得られ、予後の改善に繋がる可能性がある。},
 pages = {41--50},
 title = {Mechanical Circulatory Support as a Potentially Useful Strategy in Patients with Severe Cyclophosphamide-induced Cardiotoxicity},
 volume = {67},
 year = {2015}
}