Cyclophosphamide-Induced Cardiotoxicity in a Child with Severe Aplastic Anemia After Allogeneic Hematopoietic Stem Cell Transplantation: Case Report and Literature Review

Shengjin Fan*, Haitao Li, Donyang Zhang, Dandan Li, Jinyue Fu and Dongxue Lu

Hematology Intensive Care Unit, The First Affiliated Hospital of Harbin Medical University, China

^*Correspondance to: Shengjin Fan 

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Abstract:

Background: Severe Aplastic Anemia (SAA) is a life-threatening bone marrow failure disorder. Hematopoietic Stem Cell Transplantation (HSCT) represents a potentially curative treatment for SAA, with Cyclophosphamide (CY) being a key component of conditioning protocols. CY-induced cardiotoxicity is a rare but lethal complication. High-dose CY (200 mg/kg daily) has been identified as an independent risk factor for cardiotoxicity, whereas standard doses (50 mg/kg daily) are rarely associated with cardiotoxicity. Case Presentation: We presented an 11-year-old child with SAA who underwent allogeneic HSCT. Following the completion of standard-dose CY administration (50 mg/kg/day for 4 days), the patient developed severe CY-induced cardiotoxicity 120 hours after the final dose, accompanied by severe Cytokine Release Syndrome (CRS)-related multi-organ dysfunction. She was urgently transferred to the Hematology Intensive Care Unit (HCU). Management included glucocorticoids and anti-IL-6 receptor therapy (tocilizumab) to mitigate CRS, alongside Continuous Renal Replacement Therapy (CRRT) for volume control, pulmonary edema management, and cytokine adsorption. Despite initial clinical deterioration during the first three days of HCU admission, the patient demonstrated progressive improvement with this therapeutic regimen. Conclusion: This case underscores the critical need for vigilant monitoring of severe complications in the immediate post-HSCT period, particularly given the risk of CY-induced cardiotoxicity. Improved outcomes may be attributed to early diagnosis and timely management in the HCU.  

Keywords:

Severe aplastic anemia; Cyclophosphamide; cardiotoxicity; hematopoietic stem cell transplantation

Cite the Article:

Fan S, Li H, Zhang D, Li D, Fu J, Lu D. Cyclophosphamide- Induced Cardiotoxicity in a Child with Severe Aplastic Anemia After Allogeneic Hematopoietic Stem Cell Transplantation: Case Report and Literature Review. Clin Case Rep Int. 2026; 10: 1748.