Clinical prevalence and outcome of cardiovascular events in the first 100 days postallogeneic hematopoietic stem cell transplant

Abstract

Introduction Recent advances in allogeneic hematopoietic stem cell transplant (HSCT) have allowed us to offer HSCT to older, advanced disease patients with more co‐morbidities. Cardiovascular toxicity post‐transplant is a major concern due to the increased risk of mortality. Few studies have examined the prevalence of CV events including CAD (MI, angina, PCI, CABG, CHF, arrhythmias), HTN, stroke/TIA, and death in the first 100 days post‐transplant. Patients We assessed the impact of pretransplant MUGA results in predicting postallogeneic HSCT CV events and overall survival in the first 100 days, and whether or not transient anthracycline‐induced cardiomyopathy or cumulative anthracycline dose affected overall survival. This retrospective, cohort study included 665 patients with a median age of 52 years who underwent HSCT from 2009 to 2015. Results The most frequent CV event in the first 100 days post‐HSCT was arrhythmia seen in 2.9% of patients followed up by CHF (12.3%), MI (9%), and angina (8%). Two patients had PCI, and both survived the first 100 days. Cardiovascular risk factors predict for a poor MUGA scan but not survival. Higher dose anthracycline pretransplant predicted for a poor outcome. Conclusion A history of CV disease, MI, or CAD was the most important predictive of CV events, P‐value = .00002. 88.6% survived the first 100 days. Patients with an EF < 50% had a significant likelihood of having a CV event compared to patients with an EF > 60% (OR = 5.3, 95% CI [1.6‐18.1], P = .0219). Cumulative anthracycline dose did not have a significant impact on overall survival.

Increased risk of cardio-cerebrovascular disease after hematopoietic cell transplantation in patients with previous history

“…[ 23 ] Our multivariable analysis showed that post-CCVD was significantly affected by pre-CCVD ( P < 0.001). Alblooshi et al [ 24 ] recently demonstrated that a history of CV disease, myocardial infarction, or CAD was the most important predictor of CV events in the first 100 days after HCT ( P = 0.00002). A controlled study found that cardiac autonomic functioning was impaired 1 to 10 years after allo-HCT, which may be associated with post-CCVD.…”

“…There was no difference in the median days of neutrophil (14 [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24] vs. 12 [9-21] days, P = 0.269) and platelet (14 vs. 14 days, P = 0.395) engraftment between the pre-CCVD group and the control group. In the multivariable analysis, rapid neutrophil recovery was associated with a greater number of infused CD34 + cells (P = 0.016) and disease status in remission (P = 0.002).…”

Mulberry leaf attenuates atherosclerotic lesions in patients with coronary heart disease possibly via 1‐Deoxynojirimycin: A placebo‐controlled, double‐blind clinical trial

“…DNJ is the main ingredient of ML and serum levels of DNJ had a strong negative relationship with the MAX IMT values (Figure 7). The severity of carotid atherosclerosis is often evaluated by MAX IMT (Alblooshi et al., 2020). Thus, ML attenuated atherosclerotic lesions possibly via its main ingredient DNJ.…”

“…Clinical outcome included the occurrence of cerebrovascular and cardiovascular events and measured after a 12‐month intervention. The events included cardiovascular death; nonfatal myocardial infarction; nonfatal cerebral stroke excluding transient ischemic attack; hospital admission and all coronary revascularizations with either PCI or CABG (Alblooshi et al., 2020; Bonsu et al., 2020; Yamashita et al., 2020; You et al., 2020). The following parameters were also measured, including survival time without events, the values of the intima–media thickness (IMT) of carotid arteries, and severe side effects and their frequency.…”

Cerebrovascular manifestations in hematological diseases: an update

“…The risk of stroke is 15 × higher than in the general population [ 87 ]. Three recent series [ 88 – 90 ] found low frequencies of both of PRES (4%) and stroke (< 1% in the first 100 days [ 79 ] to 10% in longer follow-up). While PRES usually occurs early (up to 100 days) after transplantation, ischemic stroke may occur early, late (up to 2 years), or very late, while intracerebral hemorrhage happens predominantly early on [ 88 ].…”