Cardiac and cardiovascular consequences after haematopoietic stem cell transplantation

Thewis, André; Bhatia, Smita; Socié, Gèrard

doi:10.1111/j.1365-2141.2008.07165.x

Cited by 131 publications

(126 citation statements)

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“…[52][53][54] Noninfectious causes of organ failure are usually diagnosed after exclusion of infections. They are mainly represented by cardiac edema, treatment toxicity, 39,40,[54][55][56][57][58][59][60][61][62][63] hemorrhages, GvHD, long-term allo-HSCT complications, 60,64 comorbidity decompensation and relapse. Several post-allograft complications can occur, but they do not all occur at any particular stage of the disease.…”

Section: Introductionmentioning

confidence: 99%

Critically ill allogeneic hematopoietic stem cell transplantation patients in the intensive care unit: reappraisal of actual prognosis

Saillard

Blaise

Mokart

2016

Bone Marrow Transplant

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The outcome of allogeneic hematopoietic stem cell transplantation (allo-HSCT) patients has significantly improved over the past decade. Still, a significant number of patients require intensive care unit (ICU) management because of life-threatening complications. Literature from the 1990s reported extremely poor prognosis for critically ill allo-HSCT patients requiring ICU management. Recent data justify the use of ICU resources in hematologic patients. Yet, allo-HSCT remains an independent variable associated with mortality. However, outcomes in allo-HSCT patients have improved over time and many classic determinants of mortality have become irrelevant. The main actual prognostic factors are the need for mechanical ventilation, the presence of GvHD and the number of organ failures at ICU admission. Recently, the development of reduced-intensity conditioning regimens, early ICU admission and the increased use of noninvasive ventilation, combined with time effect and general advances in hematology, in allo-HSCT procedures and in ICU management have contributed to improve general outcome. A rational policy of ICU admission triage in these patients is very hard to define, as each decision for ICU admission is a case-by-case decision at patient bedside. The collaboration between hematologists and intensivists is crucial in this context.

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Section: Introductionmentioning

confidence: 99%

Critically ill allogeneic hematopoietic stem cell transplantation patients in the intensive care unit: reappraisal of actual prognosis

Saillard

Blaise

Mokart

2016

Bone Marrow Transplant

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“…However, chronic complications, such as cardiovascular disease, have become increasingly evident and constitute a serious problem in long-term survivors of HCT. [1][2][3] It is well known that the high-dose CY used for conditioning is a major cause of acute cardiotoxicity after HCT. 4,5 However, it is still unclear as to which factors contribute to chronic cardiotoxicity after HCT.…”

Section: Introductionmentioning

confidence: 99%

Risk factors affecting cardiac left-ventricular hypertrophy and systolic and diastolic function in the chronic phase of allogeneic hematopoietic cell transplantation

Nishimoto

Nakamae

Koh

et al. 2012

Bone Marrow Transplant

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Chronic impairment of cardiac function can be an important health risk and impair the quality of life, and may even be life-threatening for long-term survivors of allogeneic hematopoietic cell transplantation (HCT). However, risk factors for and/or the underlying mechanism of cardiac dysfunction in the chronic phase of HCT are still not fully understood. We retrospectively investigated factors affecting cardiac function and left-ventricular hypertrophy (LVH) in the chronic phase of HCT. Sixty-three recipients who survived for 41 year after receiving HCT were evaluated using echocardiography. Based on simple linear regression models, high-dose TBI-based conditioning was significantly associated with a decrease in left-ventricular ejection fraction and the early peak flow velocity/atrial peak flow velocity ratio, following HCT (coefficient ¼ À 5.550, P ¼ 0.02 and coefficient ¼ À 0.268, P ¼ 0.02, respectively). These associations remained significant with the use of multiple linear regression models. Additionally, the serum ferritin (s-ferritin) level before HCT was found to be a significant risk factor for LVH on multivariable logistic analysis (P ¼ 0.03). In conclusion, our study demonstrated that a myeloablative regimen, especially one that involved high-dose TBI, impaired cardiac function, and that a high s-ferritin level might be associated with the development of LVH in the chronic phase of HCT.

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“…14,15 Anthracycline chemotherapy and neck/mediastinal radiation are the most common causes of therapy-related cardiovascular complications in long-term cancer survivors. 11,19 Anthracycline cardiotoxicity has been well-described and is thought to be related to direct myocardial injury due to formation of free radicals. …”

mentioning

confidence: 99%

“…[11][12][13] Arterial complications can occur as a result of damage to the entire vascular system and include coronary artery disease, cerebrovascular disease, and peripheral artery disease.…”

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confidence: 99%

“…The cardiotoxic potential of many anti-neoplas- 19 Older patients have a reduced capacity to repair tissue damage and, in turn, have a greater risk of premature coronary artery disease, congestive heart failure, and dysrhythmia. 11,20 Females exposed to anthracyclines have a significantly greater risk of developing CHF compared to males. 21 The mechanism of gender-specific cardiotoxicity is not clear.…”

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confidence: 99%

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Cardiovascular disease after hematopoietic cell transplantation - lessons learned

Armenian¹,

Bhatia²

2008

Haematologica

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H ematopoietic cell transplantation (HCT) has now become the treatment of choice for a large number of malignant and non-malignant diseases.1 It is quite clear that unless effective targeted therapy becomes available, HCT will continue to be offered as a curative therapeutic modality to patients diagnosed with a variety of malignant and non-malignant disorders. Among those who survive the first 2 years, nearly 80% of allogeneic HCT recipients 2,3 and 70% of autologous HCT recipients 4 are expected to become long-term survivors, with an attendant growth in such survivors. Due to improvements in survival rate, major issues for patients undergoing HCT have expanded to include the care and management of survivors, prevention of adverse outcomes, and maintenance of a good health-related quality of life. Some of the well-described complications in this population include subsequent malignancies, cataracts, pulmonary complications, endocrine dysfunction, osteonecrosis, chronic kidney disease, and impairment in functional status due to persistent, chronic graft-versus-host disease (GVHD).5-7 Details regarding cardiovascular dysfunction after HCT are now emerging. [8][9][10] In this issue of the journal, Tichelli et al. publish the results of their retrospective study designed to describe the magnitude of risk of and associated risk factors for the development of arterial events after allogeneic HCT. 10 The events of interest include coronary artery disease, cerebrovascular disease and peripheral artery disease. They report that the cumulative incidence of arterial events at 15 years is 6%, and identify older age at the time of HCT and presence of pre-established cardiovascular risk factors (diabetes, obesity, dyslipidemia, arterial hypertension) as being associated with an increased risk of these outcomes.In a recent study, we used a nested case-control study design to examine the independent role of pre-HCT exposure to therapeutic agents, transplant-related conditioning and co-morbidities in the development of congestive heart failure (CHF) after HCT. 8,9 We identified pre-HCT exposure to anthracyclines and the presence of post-HCT co-morbidities as being associated with delayed CHF after HCT.The best-described therapy-related late cardiac complications include valvular dysfunction, conduction abnormalities, pericarditis, and cardiomyopathy. [11][12][13] Arterial complications can occur as a result of damage to the entire vascular system and include coronary artery disease, cerebrovascular disease, and peripheral artery disease.14,15 While the latency period for many of these diseases can be short, survivors often do not have clinical evidence of disease until several years following HCT.14-16 As with most other complications observed after HCT, cardiovascular complications following HCT are due, in part, to the treatment prior to, during, and following HCT.Age at therapeutic exposure, gender, and past medical history are important considerations when identifying the potential risk of long-term cardiovascular disease. ...

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Cardiac and cardiovascular consequences after haematopoietic stem cell transplantation

Cited by 131 publications

References 130 publications

Critically ill allogeneic hematopoietic stem cell transplantation patients in the intensive care unit: reappraisal of actual prognosis

Critically ill allogeneic hematopoietic stem cell transplantation patients in the intensive care unit: reappraisal of actual prognosis

Risk factors affecting cardiac left-ventricular hypertrophy and systolic and diastolic function in the chronic phase of allogeneic hematopoietic cell transplantation

Cardiovascular disease after hematopoietic cell transplantation - lessons learned

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