Treatment of Dyslipidemia in Allogeneic Hematopoietic Stem Cell Transplant Patients

Abstract

As survival rates in allogeneic hematopoietic stem cell transplantation (HSCT) continue to improve, attention to long-term complications, including cardiovascular disease, become a major concern. Cardiovascular disease and dyslipidemia are a common, yet often overlooked occurrence post-HSCT that results in significant morbidity and mortality. There is also increasing evidence that several anti-hyperlipidemia medications, the HMG-CoA reductase inhibitors in particular, may have a role in modulating graft-versus-host disease (GVHD). However, factors such as drug-drug interactions, adverse effect profiles, and the relative efficacy in lowering cholesterol and triglyceride levels must be taken into account when choosing safe and effective lipid lowering therapy in this setting. This review seeks to provide guidance to the clinician in the management of dyslipidemia in the allogeneic HSCT population, taking into account the recently published ACC/AHA guidelines on hyperlipidemia management, special considerations in this challenging population, and the evidence for each agent’s potential role in modulating GVHD.

Rhabdomyolysis after Transplantation: Case Report after Allogeneic Hematopoietic Transplantation and Review of Literature

“…We assume that posaconazole might have contributed, even though posaconazole has the lowest inhibitory activity of any azole against CYP3A4 [51,52] and although posaconazole was administered at low dosage. Our case confirms that the use of simvastatin in a patient taking cyclosporine and posaconazole should be avoided [53]. However, posaconazole is widely used after allogeneic transplantation, because it is considered to be the first-line drug for antifungal prophylaxis for patients with GVHD who are being treated with cyclosporine and corticosteroids [54].…”

“…Therefore, fluvastatin may be a safer choice for patients treated with cyclosporine who need a statin [56]. Other agents that may be safe to use for hyperlipidemia in cases requiring concomitant cyclosporine treatment are fibrate and niacin [53]. In addition, if a patient on cyclosporine is prescribed simvastatin, its dosage should be reduced [57].…”

A Pound of Cure Requires An Ounce (or More) of Prevention: Survivorship and Complications of Therapy for Hematologic Malignancies

“…Hypertension, dyslipidemia, and diabetes are common, necessitating periodic CV assessments [120,123]. Non-medical toxicities of alloHCT include financial stress, economic disability, and caregiver burnout [124][125][126].…”

Cardiovascular disease following hematopoietic stem cell transplantation: Pathogenesis, detection, and the cardioprotective role of aerobic training

“…Although the mechanisms underlying HCT allogenic-specific CVD have not yet been well described, certain generalizations can be extrapolated from solid organ transplant recipients where immunosuppressive agents (including glucocorticoids, calcineurin inhibitors, and sirolimus) are well-known to contribute to CVD pathogenesis. 81 82–84 For instance, dyslipidemia has been reported in up to 80% of solid-organ transplantation patients on immunosuppressive agents, and insulin resistance and hypertension are frequently encountered side-effects of immunosuppressive medications. 7,11,85 …”