Nonbacterial thrombotic endocarditis in bone marrow transplant patients

We reviewed the findings in 2381 consecutive autopsies, a series containing 91 bone marrow transplant (BMT) patients, and found 45 cases of nonbacterial thrombotic endocarditis (NBTE). The overall prevalence of NBTE was 1.9%. NBTE was present in seven BMT patients, for a prevalence of 7.7%. The rate of NBTE in BMT patients was significantly greater than the rate of NBTE in the general autopsy population (P < 0.001). The frequency of NBTE was not increased in patients with the individual underlying diseases for which BMT was a possible treatment (the BMT candidate diseases [BMTCD]). When rates of NBTE were compared in patients with BMTCD, there was a significantly higher rate in patients who had received BMT than in those who had not (P < 0.02). These findings indicate that NBTE occurs with greater frequency in BMT patients and that there may be features of the BMT regimen that predispose patients to develop NBTE. Although several factors related to BMT are discussed as potential contributors to the increased prevalence of NBTE, we were not able to demonstrate an association between NBTE and any single factor. Since NBTE is an important cause of arterial embolization, an awareness of the increased frequency of NBTE in BMT patients is important for clinicians who must interpret neurologic and other abnormalities in BMT recipients.