Endothelial Function in Patients with Hematologic Malignancies Undergoing High-Dose Chemotherapy Followed by Hematopoietic Stem Cell Transplantation

Poręba, Małgorzata; Gać, Paweł; Usnarska−Zubkiewicz, Lidia; Pilecki, Witold; Kuliczkowski, Kazimierz; Mazur, Grzegorz; Sobieszczańska, Małgorzata; Poręba, Rafał

doi:10.1007/s12012-015-9324-0

Cited by 11 publications

(6 citation statements)

References 19 publications

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“…Radiotherapy has been shown to accelerate plaque deposition, while certain classes of chemotherapeutic agents (eg. alkylating agents, anthracyclines, antiangiogenics) are reported to cause direct injury to the endothelium [ 13 , 14 , 18 , 19 ]. We observed improvements in delta diameter, FMD and time to peak in brachial artery function after exercise training.…”

Section: Discussionmentioning

confidence: 99%

“…The invasive nature of cancer and its treatment during childhood may limit physical performance and exacerbate cardiovascular disease (CVD) risk during adolescence and young adulthood [ 8 – 11 ]. Cardiotoxicity is a well-known side effect of certain chemotherapeutic agents, most notably the anthracyclines [ 12 – 14 ]. Specifically, the anthracyclines have direct toxic effects on the vascular endothelium and cardiac myocytes, with a dose dependent relationship resulting in clinical heart failure at cumulative doses > 550mg/m 2 [ 15 ].…”

Section: Introductionmentioning

confidence: 99%

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Exercise training improves vascular function and secondary health measures in survivors of pediatric oncology related cerebral insult

et al. 2018

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Adolescent and young adult (AYA) survivors of pediatric oncology related cerebral insult are vulnerable to numerous treatment-induced deficits that significantly enhance cardiovascular disease risk. Regular exercise improves endothelial function, fitness, body composition and musculoskeletal function which may reduce predisposition for cardiovascular disease. Here we assessed the feasibility and effectiveness of a 24-week exercise intervention on cardiovascular, physical and metabolic outcomes in this population. Thirteen survivors (6 male, 7 female; median age 19 y (range 16–23 y) were recruited to participate in a 48-week study consisting of a 24-week control period (regular care) followed by a 24-week exercise intervention. Outcome measures were collected at entry (week 0) and following regular care (24-week) and exercise (48-week). Assessed variables included endothelial function (flow mediated dilation, FMD), blood pressure, heart rate (HR), aerobic capacity, anthropometry, body composition, muscular strength (3 repetition maximum testing), muscular endurance (repetitions/min) and physical activity levels (accelerometry). Compared to baseline, delta diameter (p = 0.008) and FMD (p = 0.029) of the brachial artery increased following exercise. Bicep-curl strength also increased following exercise compared to baseline (p = 0.019), while submaximal (6 min mark) measures of ventilation (p = 0.012), rating of perceived exertion (p = 0.012), HR (p = 0.001), absolute (p = 0.000) and relative (p = 0.000) aerobic capacity decreased. Breaks in sedentary time increased (p = 0.043) following exercise compared to regular care. Although the sample was small and heterogeneous, this study demonstrates that exercise is achievable and has positive effects on vascular function, submaximal fitness, local strength and physical activity in a population of AYA survivors of pediatric oncology related cerebral insult.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Exercise training improves vascular function and secondary health measures in survivors of pediatric oncology related cerebral insult

et al. 2018

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“…In HCT survivors, indices of endothelial dysfunction have only recently been evaluated, and available data are limited [18,19,21]. Poreba et al [21] found significantly impaired FMD after autologous and allogeneic HCT. Administration of fludarabine and cytarabine, as well as increased creatinine, was associated with impaired FMD [21].…”

Section: Endothelial Dysfunctionmentioning

confidence: 99%

Early Prediction of Cardiovascular Risk after Hematopoietic Cell Transplantation: Are We There Yet?

Gavriilaki

Gkaliagkousi

Sakellari

et al. 2019

Biology of Blood and Marrow Transplantation

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Cardiovascular (CV) events have emerged as a major cause of morbidity and mortality among hematopoietic cell transplantation (HCT) survivors. Accumulating evidence supports the presence of increased CV risk in HCT recipients. Most studies have focused mainly on traditional CV risk factors, such as the metabolic syndrome and hypertension. However, detection of these factors suggests the development of irreversible overt clinical atherosclerosis. Therefore, earlier prediction of CV risk is needed to prevent CV morbidity and mortality in these patients. In the field of CV research, endothelial dysfunction is considered an early event in the pathophysiology of CV risk factors, and a number of markers have been proposed for its assessment. In addition, markers of subclinical target organ damage have been introduced to implement CV risk prediction and early preventive or intensive therapeutic interventions. Furthermore, a number of CV models have been suggested aiming for optimal stratification of patients. Preliminary studies have indicated excess CV risk using these early markers in HCT recipients. However, their role in the pathophysiology and clinical practice in HCT survivors remains largely understudied. Taking into account the need for increased awareness from treating physicians in this evolving setting, we conducted a state-of-the-art review aiming to summarize current knowledge on endothelial dysfunction, subclinical target organ damage, and CV risk prediction in HCT survivors.

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“…In alloHCT survivors, indices of endothelial injury have been evaluated in limited recent studies with heterogenous populations [ 34 , 35 , 36 ]. Using the gold standard vascular method of flow-mediated dilatation (FMD), autologous and allogeneic HCT recipients had impaired endothelial dysfunction compared to values prior HCT [ 34 ] and their siblings [ 36 ]. By contrast, when compared to age- and sex-matched controls, no difference in endothelial dysfunction was observed in childhood alloHCT survivors [ 35 ].…”

Section: Discussionmentioning

confidence: 99%

Assessment of Endothelial Injury and Pro-Coagulant Activity Using Circulating Microvesicles in Survivors of Allogeneic Hematopoietic Cell Transplantation

Gavriilaki

Sakellari

Anyfanti

et al. 2020

IJMS

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(1) Background: survivors of allogeneic hematopoietic cell transplantation (alloHCT) suffer from morbidity and mortality due to cardiovascular events. We hypothesized that vascular injury and pro-coagulant activity are evident in alloHCT survivors without existing alloHCT complications or relapse. (2) Methods: we enrolled consecutive adult alloHCT survivors without established cardiovascular disease and control individuals matched for traditional cardiovascular risk factors (January–December 2019). Circulating microvesicles (MVs) of different cellular origins (platelet, erythrocyte, and endothelial) were measured by a standardized flow cytometry protocol as novel markers of vascular injury and pro-coagulant activity. (3) Results: we recruited 45 survivors after a median of 2.3 (range 1.1–13.2) years from alloHCT, and 45 controls. The majority of patients suffered from acute (44%) and/or chronic (66%) graft-versus-host disease (GVHD). Although the two groups were matched for traditional cardiovascular risk factors, alloHCT survivors showed significantly increased platelet and erythrocyte MVs compared to controls. Within alloHCT survivors, erythrocyte MVs were significantly increased in patients with a previous history of thrombotic microangiopathy. Interestingly, endothelial MVs were significantly increased only in alloHCT recipients of a myeloablative conditioning. Furthermore, MVs of different origins showed a positive association with each other. (4) Conclusions: endothelial dysfunction and increased thrombotic risk are evident in alloHCT recipients long after alloHCT, independently of traditional cardiovascular risk factors. An apparent synergism of these pathophysiological processes may be strongly involved in the subsequent establishment of cardiovascular disease.

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Endothelial Function in Patients with Hematologic Malignancies Undergoing High-Dose Chemotherapy Followed by Hematopoietic Stem Cell Transplantation

Cited by 11 publications

References 19 publications

Exercise training improves vascular function and secondary health measures in survivors of pediatric oncology related cerebral insult

Exercise training improves vascular function and secondary health measures in survivors of pediatric oncology related cerebral insult

Early Prediction of Cardiovascular Risk after Hematopoietic Cell Transplantation: Are We There Yet?

Assessment of Endothelial Injury and Pro-Coagulant Activity Using Circulating Microvesicles in Survivors of Allogeneic Hematopoietic Cell Transplantation

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