Cardiovascular Complications in Hematopoietic Stem Cell Transplanted Patients

Abstract

Hematopoietic stem cell transplantation (HSCT) is the only curative treatment for many patients suffering from hematologic malignancies, solid tumors, inborn errors of metabolism or genetic disorders. Despite decades of successful HSCT, clinical outcomes are still far from satisfactory due to treatment-related complications, including graft-versus-host disease (GvHD) and cardiovascular complications (CVC). CVC may affect patients in the acute period post-HSCT; however, the occurrence is far higher among long-term survivors. Induction treatment using cardiotoxic treatments, e.g., anthracyclines and radiotherapy, conditioning regimens containing cyclophosphamide, and post-HSCT comorbidities, including GvHD, are factors contributing to CVC. Cardiac function evaluation prior to and post-transplantation is an important strategy for choosing the proper conditioning regimen, HSCT protocol and post-HSCT supportive care. Cardiac systolic function evaluation by echocardiography, in addition to serum cardiac biomarkers, such as troponins and brain natriuretic peptides, is recommended as a routine follow-up for HSCT patients. Angiotensin-converting enzyme inhibitors, angiotensin-II-receptor blockers, and beta-blockers, which are mostly used for the treatment of chemotherapy-induced cardiotoxicity, might be used as treatments for HSCT-related CVC. In summary, the present review reveals the urgent need for further investigations concerning HSCT-related CVC both at the preclinical and clinical levels due to the lack of knowledge about CVC and its underlying mechanisms.

Cancer treatment-related cardiotoxicity: a focus on sacubitril/valsartan

“…Protease inhibitor [37][38][39] Bortezomil/carfezomil CHF/myocardial ischemia/hypertension 1.8-7.2 Endocrinotherapy [40] Goserin/levoprorelin/flutamide/bicalutamide Myocardial infarction/CHF 0.1-5 CART cell therapy [41,42] Tisagenlecleucel/axicabtagene ciloleucel Tachycardia/hypotension/cardiac insufficiency Unclear Arsenic trioxide [43,44] Arsenic trioxide/all-trans retinoic acid Prolonged QT interval/tachycardia 16 Hematopoietic stem cell transplantation [45] Lenalidomide, bortezomib, Isazzomib Arrhythmia/myocardial ischemia/CHF 2-12…”

“…Patients who began taking sacubitril/valsartan in hospital had a lower risk profile for heart failure rehospitalization and cardiovascular death than patients with a delayed initiation of sacubitril/valsartan (8 weeks later) [39] . The clinical trials of sacubitril/valsartan in HFrEF were shown in Table 2 [37][38][39][40][41][42][43][44][45][46][47][48] . LV remodeling was crucial in progression to HFrEF [70] .…”

How to improve the outcomes of elderly acute myeloid leukemia patients through allogeneic hematopoietic stem cell transplantation

“…Cardiovascular complications after HSCT include ischemic heart disease, cardiomyopathy, vascular disease, etc. ( 125 ) The use of anthracycline drugs, cyclophosphamide-containing conditioning regimen, and chest radiotherapy can increase cardiotoxicity and thus increase the risk of cardiovascular complications after HSCT ( 126 ). Therefore, it is very important for elderly patients to select appropriate treatment programs based on cardiac function before and after HSCT and to follow up serum cardiac markers and echocardiography regularly after HSCT.…”

Unlocking the Potential of Immunotherapy in Cardiovascular Disease: A Comprehensive Review of Applications and Future Directions

“…Macrophages, as previously stated, have a pivotal role in the development of atherosclerosis. Foam cells are formed when macrophages engulf oxidized LDL, thereby playing a significant role in the development of plaque [ 11 ]. Macrophages are known to secrete pro-inflammatory cytokines, matrix metalloproteinases (MMPs), and various enzymes that contribute to the process of inflammation and destabilization of plaque [ 12 ].…”