Cardiac insufficiency / toxicity has been recognized as a complication of intensive cytotoxic therapy used in stem cell transplant setting. The incidence of clinically significant cardiac toxicity following high dose chemotherapy ranges between 2 - 43% with mortality of 2 - 9%. Two patients are reported who developed life-threatening cardiac complications following cyclophosphamide and busulphan therapy requiring pericardiocentesis and pericardiectomy.