National Institutes of Health Hematopoietic Cell Transplantation Late Effects Initiative: The Cardiovascular Disease and Associated Risk Factors Working Group Report

Abstract

A number of studies have shown that autologous and allogeneic hematopoietic cell transplantation (HCT) contribute to an increased incidence of cardiovascular disease (CVD) and worsening of cardiovascular risk factors (CVRFs) that could contribute to further CVD over time. These observations combined with a notable increase in the number of survivors after HCT in recent years highlight the need for studies aimed at modifying risk or preventing these outcomes by changing specific approaches and/or post-HCT interventions. To address these issues, an international consensus conference on late effects after HCT was held in Washington DC in June 2016. This report summarizes the major gaps in knowledge along with detailed recommendations regarding study priorities from the Cardiovascular Disease and Associated Risk Factors Committee, a multi-disciplinary panel of international experts. The committee calls for specific studies aimed at understanding and preventing arterial disease and cardiac dysfunction (heart failure, valvular disease, and arrhythmias), as well as decreasing cardiovascular risk factors (hypertension, hyperglycemia, dyslipidemia, and sarcopenic obesity) after HCT.

National Institutes of Health Hematopoietic Cell Transplantation Late Effects Initiative: The Patient-Centered Outcomes Working Group Report

“…Years after treatment, survivors have high rates of sexual dysfunction, fatigue, sleep disruption, pain, cognitive dysfunction, emotional distress, financial toxicity, and non-adherence to medications and health care guidelines. They maintain low levels of physical activity and poor diets that can adversely affect their cardiometabolic health (168). Those at higher risk for multiple poor outcomes include: adolescents and young adults, those with lower income, females (except for medical adherence where males have poorer adherence) and survivors with active cGVHD.…”

Prediction of cardiovascular disease among hematopoietic cell transplantation survivors

“…This can be done in the form of early screening and aggressive management of hypertension or diabetes, or by survivors' adoption of a heart healthy lifestyle, incorporating diet modification and exercise to reduce long-term CVD risk. 40,41 Such strategies have been effective in the general population 42-44 and interventions are under way for other cancer survivor populations at high risk for developing CVD. [45][46][47][48] Future CVD risk-reduction strategies for HCT survivors will benefit from a personalized approach, taking into consideration the physical limitations associated with complications such as GVHD and the burden of other chronic health conditions that develop after HCT.…”

Cardiotoxicity and cardiomyopathy in children and young adult survivors of hematopoietic stem cell transplant

“…Various cardiovascular complications including vascular disease, heart failure, valvular heart disease, dysrhythmias, hypertension, and metabolic syndrome are known to affect long‐term survivors of HSCT . Among these complications, left ventricular systolic dysfunction (LVSD) is the most well studied and the focus of this review.…”

“…Long‐term HSCT survivors have a high prevalence of metabolic syndrome and allogeneic HSCT is associated with premature cardiovascular disease . Accordingly, the National Institutes of Health Hematopoietic Cell Transplantation Late Effects Initiative has called for specific studies aimed at understanding and preventing arterial disease, cardiac dysfunction, and cardiovascular risk factors after HSCT …”

“…Effects Initiative has called for specific studies aimed at understanding and preventing arterial disease, cardiac dysfunction, and cardiovascular risk factors after HSCT. 59 Adult patients have a high prevalence of iron overload at 28 months after HSCT. 60 Although liver iron content is not associated with mortality in HSCT patients, 61 patients with iron overload would be expected to also have higher levels of cardiac iron deposition.…”