Late Congestive Heart Failure After Hematopoietic Cell Transplantation

Abstract

Purpose To examine the independent roles of pre–hematopoietic cell transplantation (HCT) therapeutic exposures, transplantation-related conditioning, and comorbidities (pre- and post-HCT) in the development of late congestive heart failure (CHF) after HCT. Methods This was a nested case-control design. Individuals with late CHF (diagnosed ≥ 1 year after HCT) were identified from a cohort of 2,938 1+ year survivors who underwent transplantation at City of Hope National Medical Center, Duarte, CA. This cohort formed the sampling frame for selecting controls (without CHF) matched for age and year of HCT, donor source (allogeneic v autologous), and length of follow-up. Results Sixty patients with late CHF were identified; median age at HCT was 45.3 years (range, 16.6 to 68.6 years); median time to CHF was 3.0 years (range, 1.03 to 18.9 years); 68% received autologous HCT. Median ejection fraction was 36.9% (range, 15% to 53%). Compared with matched controls (n = 166), patients with late CHF received more cycles of pre-HCT chemotherapy (8.6 v 4.9 cycles; P < .01), had greater body mass index at HCT (28.4 v 26.2 kg/m2; P = .01), greater lifetime anthracycline exposure (285.3 v 175.6 mg/m2; P < .01), and were more likely to have multiple chronic comorbidities (30.0% v 13.9%; P < .01). Multivariable analysis revealed number of pre-HCT chemotherapy cycles (odds ratio [OR] = 1.2; P < .01), anthracycline dose ≥ 250 mg/m2 (OR = 3.2; P = .05), and two or more chronic comorbidities (OR = 4.3; P = .01) to be independently associated with late CHF. Conclusion Pre-HCT exposure to anthracyclines and presence of comorbidities are primarily responsible for the risk associated with late CHF after HCT. Conditioning-related therapeutic exposure does not contribute significantly to the risk. These results form the basis for identifying high-risk individuals for targeted surveillance, as well as developing preventive strategies in the form of aggressive management of comorbidities.

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

“…[21][22][23][24] However, a larger, retrospective cohort study showed no statistically significant difference in the incidence of congestive heart failure among patients with acute GVHD, those with a history of chronic GVHD and Cardiac dysfunction in the chronic phase of HCT M Nishimoto et al those with active GVHD. 25 Uderzo et al 13 report similar findings in childhood HCT. This study was limited by its retrospective, nonrandomized design and small study population.…”

The non‐relapse mortality rate for patients with diffuse large B‐cell lymphoma is greater than relapse mortality 8 years after autologous stem cell transplantation and is significantly higher than mortality rates of population controls

“…In general, patients who survive 5 years after transplantation without relapse are considered to be cured of disease. However, there is increasing evidence of the deleterious long-term health consequences of ASCT, including increased rates of treatment-related myelodysplasia/leukaemia, secondary solid tumours, and cardiac and pulmonary toxicity (Pedersen-Bjergaard et al, 2000;Bhatia et al, 2005;Brown et al, 2005;Kalaycio et al, 2006a,b;Armenian et al, 2008). In a comprehensive study of late mortality in survivors of ASCT, Bhatia et al (2005) revealed that mortality exceeds those of the general population until 10 years after ASCT in certain subgroups of patients.…”

“…Patients who have undergone ASCT for relapsed or refractory DLBCL are at increased risk of mortality well beyond 5 years, which is the time point that has been widely accepted a surrogate for long-term survival (Pedersen-Bjergaard et al, 2000;Bhatia et al, 2005;Brown et al, 2005;Kalaycio et al, 2006a,b;Armenian et al, 2008). Whether deaths occurring after 5 years are due to disease relapse mortality (RM) or nonrelapse mortality (NRM) is poorly studied.…”

Comorbidities and Hematopoietic Cell Transplantation Outcomes

“…Further, preceding Ն 2 comorbidities were associated with increased post-HCT congestive heart failure. 63 A study from MDACC found increased incidence of post-HCT cardiac toxicities if patients had one of seven preceding cardiac comorbidities. 64 Clearly, additional investigations are required to better predict and prevent organ toxicity based on preexisting multiple comorbidities.…”