الفهرس 
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Abstract
S
UMMARY
espite increasing the survival rate among pediatric HSCT in recent years, children have been shown to develop specific late effects that are associated with either the underlying disease or the treatment itself. In fact, death from cardiovascular events has become the third leading cause of mortality after malignancies and chronic GVHD.
Cardiotoxicity in HSCT is multifactorial which may occur at any step during trip of the transplantation. Although many anti-neoplastic therapies are cardiotoxic, anthracycline-induced cardiomyopathy and heart failure (HF) are prototypical and the most thoroughly studied.
There are various cardiovascular complications including vascular disease, heart failure, valvular heart disease, arrhythmia, hypertension, and metabolic syndrome are known to affect long-term survivors of HSCT.
Echocardiography is the method of choice for detecting myocardial dysfunction before, during, and after cancer therapy. Cardiotoxicity was defined as a decrease in LVEF of >10% from the baseline cardiac function or ejection fraction ≤50%, which is defined as the lower limit of normal.
The aim of this study was to assess the long-term effect of pediatric HSCT on the heart in long term survivors of
D
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children more than one year post HSCT by the usage of both conventional and 2D Speckle tracking echo.
We conducted cross sectional study on 22 patients who underwent HSCT with mean age of transplant (7.02 ± 3.84) years from 2011 to 2019 at Pediatric transplantation unit at Ain Shams University Hospital.
The results of our present study can be summarized as follows:
In the current study, the long-term survival mean duration was (6.29 ± 2.69).
The majority of studied patients were aplastic anemia about nine patients (41%) followed by six patients with thalassemia (27.3%). Only two patients received autologous HSCT.
Type of HSCT, allogenic type was (90.9%) and autologous type 2 was (9.1%).
Our study showed that, CMV infection was the commonest about eight patients 36%, while bacterial infections were the least (four patients 18%) among our patients & fungal infection occurred in five patients (22%).
18.1% of patients had acute GVHDs (grade I to II). The majority were skin affection (31.8%)
22.7% of patients suffered from chronic GVHDs mostly in the form of skin affection, while 13.5% had moderate to
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severe chronic GVHDs. had moderate to severe chronic GVHDs.
The current study revealed that, the conditioning regimen drugs for transplanted patients included: Cy/Bu (50%), Cy/ATG (41%), and BEAM (9%).
There were 20 out of studied patients (91%) received immunosuppressive therapy as GVHDs prophylaxis. Nine patients (40.9%) received (MTX, Cyclosporine A), while ATG was added in eleven patients (50%).
Two patients (9%) who received autologous HSCT, didn‟t receive GVHDs prophylaxis
In our study, all patients had normal systolic and diastolic function. Only one patient out of studied population was found to have borderline left ventricle dilatation by M-mode echo.
In this study according to the results of 2D speckle tracking echo; two patients had abnormal 2D speckle tracking values, one was borderline (GLS= -16 %) and the other one had mild hypokinesia (GLS= -14 %).
Our study showed that, t There was no significant difference between both groups as regards demographic data (P Value > 0.05).
There was no significant difference between both groups as regards diagnosis and the type of transplant (P value >0.05).
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We couldn‟t see significant difference between both groups as regards conditioning regimens and GVHDs prophylaxis.
In the present study, the transplant complications didn‟t significantly affect the cardiac function among our studied pediatric HSCT patients (P value > 0.05).