TY - JOUR
T1 - Late cardiovascular morbidity and mortality following pediatric allogeneic hematopoietic cell transplantation
AU - Duncan, Christine N.
AU - Brazauskas, Ruta
AU - Huang, Jiaxing
AU - Shaw, Bronwen E.
AU - Majhail, Navneet S.
AU - Savani, Bipin N.
AU - Flowers, Mary E.D.
AU - Battiwalla, Minoo
AU - Beebe, Kristen
AU - Dietz, Andrew C.
AU - Dvorak, Christopher C.
AU - Giller, Roger
AU - Jacobsohn, David A.
AU - Kletzel, Morris
AU - Martin, Paul L.
AU - Nemecek, Eneida R.
AU - Nuechterlein, Brandon
AU - Talano, Julie An
AU - Pulsipher, Michael A.
AU - Baker, K. Scott
N1 - Publisher Copyright:
© 2018, Macmillan Publishers Limited, part of Springer Nature.
PY - 2018/10/1
Y1 - 2018/10/1
N2 - We analyzed late cardiovascular outcomes of 661 patients who survived at least 2 years from hematopoietic cell transplantation for childhood hematologic malignancy between 1995 and 2008. Center for International Blood and Marrow Transplant Research data was supplemented with surveys focused on cardiotoxicity and potential risk factors. The median duration of follow-up was 97 months (range 24–230). 4.2% of survivors experienced at least one of the primary outcomes including coronary artery disease (0.2%), cerebrovascular accident (0.6%), cardiomyopathy (3%), and cardiac-related death (0.5%). Patients who received anthracycline chemotherapy (HR 4.67, p = 0.036) or cranial or chest radiation (HR 5.58, p < 0.0001; HR 2.18, p = 0.0087) were at increased risk for developing one of the primary outcomes. Dyslipidemia was diagnosed in 18% of survivors. Pre-transplant anthracycline (HR 1.74, p < 0.0001) and chest radiation (HR 1.34, p = 0.0371) were risk factors for dyslipidemia. Overweight/obese body mass status was present in 63% of patients at baseline, 65% at 2 years, and 52% at most recent evaluation. Diabetes was diagnosed in 7% of subjects. In conclusion, severe cardiovascular complications were infrequently reported. The incidence of risk factors including obesity and dyslipidemia were significant and will likely increase the risk of cardiovascular disease over time in transplant survivors.
AB - We analyzed late cardiovascular outcomes of 661 patients who survived at least 2 years from hematopoietic cell transplantation for childhood hematologic malignancy between 1995 and 2008. Center for International Blood and Marrow Transplant Research data was supplemented with surveys focused on cardiotoxicity and potential risk factors. The median duration of follow-up was 97 months (range 24–230). 4.2% of survivors experienced at least one of the primary outcomes including coronary artery disease (0.2%), cerebrovascular accident (0.6%), cardiomyopathy (3%), and cardiac-related death (0.5%). Patients who received anthracycline chemotherapy (HR 4.67, p = 0.036) or cranial or chest radiation (HR 5.58, p < 0.0001; HR 2.18, p = 0.0087) were at increased risk for developing one of the primary outcomes. Dyslipidemia was diagnosed in 18% of survivors. Pre-transplant anthracycline (HR 1.74, p < 0.0001) and chest radiation (HR 1.34, p = 0.0371) were risk factors for dyslipidemia. Overweight/obese body mass status was present in 63% of patients at baseline, 65% at 2 years, and 52% at most recent evaluation. Diabetes was diagnosed in 7% of subjects. In conclusion, severe cardiovascular complications were infrequently reported. The incidence of risk factors including obesity and dyslipidemia were significant and will likely increase the risk of cardiovascular disease over time in transplant survivors.
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U2 - 10.1038/s41409-018-0155-z
DO - 10.1038/s41409-018-0155-z
M3 - Article
C2 - 29581480
AN - SCOPUS:85044469262
SN - 0268-3369
VL - 53
SP - 1278
EP - 1287
JO - Bone marrow transplantation
JF - Bone marrow transplantation
IS - 10
ER -