Frequency of Abnormal Findings Detected by Comprehensive Clinical Evaluation at 1 Year after Allogeneic Hematopoietic Cell Transplantation

Abstract

Consensus guidelines recommend a number of screening examinations for survivors following allogeneic hematopoietic cell transplantation (HCT) but the frequency of detecting abnormal findings is unknown. We reviewed medical records of 118 patients who had comprehensive, standardized evaluations at one year after allogeneic HCT at Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance. Abnormal findings were common, including moderate-severe pulmonary dysfunction (16%), fasting hyperlipidemia (56%), osteopenia (52%), osteoporosis (6%), and active chronic graft-versus-host disease (64%). Recurrent malignancy (4%) and chronic graft-versus-host disease (29%) were detected in previously unsuspected cases. Only 3% of patients had no abnormal findings. We conclude that comprehensive evaluation at one year after allogeneic HCT detects a high frequency of medical problems. Longer follow-up will be required to determine whether early detection and intervention affects late morbidity and mortality.

Late Cardiovascular Complications after Hematopoietic Cell Transplantation

“…However, data from our study and others have shown that although these cardiovascular risk factors develop frequently after HCT, especially following allogeneic transplant, it appears that many HCT survivors do not receive specific treatment for these conditions(32;35;36). Our reliance on medication status to define cardiovascular risk factors in this study likely underestimates the true prevalence of these conditions.…”

Cardiovascular risk factors in hematopoietic cell transplantation survivors: role in development of subsequent cardiovascular disease

“…Previous studies, conducted largely in allogeneic HCT recipients, have reported wide-ranging estimates for prevalence of hypertension (15%-70%), 9,12,13,16 diabetes (7%-30%), 12,16 and dyslipidemia (16%-56%), 10,14,16 due, in part, to a variety of definitions used for CVRFs and varying lengths of follow-up of the study cohorts. In the current study, we used a conservative approach to defining CVRFs, therefore a condition had to be present for Ͼ 6 months and persist for Ͼ 1 year after HCT, highlighting the magnitude of disease burden that persists long after the immediate post-HCT period.…”

“…Although recurrence of primary disease remains the leading cause of mortality after HCT, 3,28,29 nonmalignant late effects such as CVD contribute increasingly with longer follow-up, 4-6 a problem that can be compounded by the high prevalence of CVRFs in HCT survivors, as demonstrated in the current study. Studies to date have been limited by relatively short follow-up after HCT, 12-14 reliance on questionnaire-based self-reported outcomes, 9 lack of comparison with the general population, 11,12,14 and lack of information regarding the contribution of CVRFs in the development of CVD in patients previously exposed to cardiotoxic agents such as anthracyclines and chest radiation. [15][16][17] The current study overcomes these limitations by comprehensively evaluating the risk of CVRFs and their modifying effect on subsequent development of CVD in a large cohort of HCT survivors with 11 700 person-years of followup.…”

“…8 HCT recipients may be at increased risk of developing these cardiovascular risk factors (CVRFs) because of pre-HCT and conditioning-related therapeutic exposures, as well as graft versus host disease (GVHD) and its management. [9][10][11] Previous studies evaluating CVRFs in HCT survivors have been limited by small sample sizes, 10-13 relatively short follow-up after HCT, [12][13][14] lack of evaluation among autologous HCT recipients, 10,14 lack of comparison with age-and sex-matched general population, 11,12,14 and reliance on self-reported outcomes. 9 Previous studies have also been limited by the lack of contribution of CVRFs and pre-HCT therapeutic cardiotoxic therapeutic exposure in the development of CVD.…”

Dyslipidemia after allogeneic hematopoietic stem cell transplantation: evaluation and management

“…12 Estimates of dyslipidemia in different cohorts who survived at least one year after allogeneic HSCT range from 8.9% in a Canadian group 6 to 56% of patients in a United States cohort, 71% of whom remained on immunosuppressive therapy (IST). 13 Taskinen et al reported that hypertriglyceridemia was present in 39% of a small group of 23 survivors of childhood allogeneic HSCT in Finland, excluding patients on active steroid therapy. 14 This was compared with the prevalence of 8% of patients in a group of 13 survivors of acute lymphoblastic leukemia who were treated with chemotherapy but no HSCT.…”