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Original Research |

Cardiovascular Hospitalizations and Mortality Among Recipients of Hematopoietic Stem Cell Transplantation

Eric J. Chow, MD, MPH; Beth A. Mueller, DrPH; K. Scott Baker, MD, MS; Kara L. Cushing-Haugen, MS; Mary E.D. Flowers, MD; Paul J. Martin, MD; Debra L. Friedman, MD, MS; and Stephanie J. Lee, MD, MPH
[+] Article and Author Information

From Fred Hutchinson Cancer Research Center, Seattle Children's Hospital, and University of Washington, Seattle, Washington, and Vanderbilt University and Vanderbilt-Ingram Cancer Center, Nashville, Tennessee.


Results were presented in part at the American Society of Hematology Annual Meeting, New Orleans, Louisiana, 5–8 December 2009.

Acknowledgment: The authors thank William O'Brien for assistance in linking the analytic data sets.

Grant Support: By the American Society for Blood and Marrow Transplantation, the Leukemia and Lymphoma Society, and the Seattle Children's Research Institute.

Potential Conflicts of Interest: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M10-2448.

Reproducible Research Statement:Study protocol: Not applicable. Statistical code: Available from Dr. Chow (e-mail, ericchow@u.washington.edu). Data set: Not available.

Requests for Single Reprints: Eric J. Chow, MD, MPH, Fred Hutchinson Cancer Research Center, PO Box 19024, M4-C308, Seattle, WA 98109; e-mail, ericchow@u.washington.edu.

Current Author Addresses: Drs. Chow, Mueller, Baker, Flowers, Martin, and Lee and Ms. Cushing-Haugen: Fred Hutchinson Cancer Research Center, PO Box 19024, Seattle, WA 98109.

Dr. Friedman: Vanderbilt Ingram Cancer Center, 2525 West End Avenue, Nashville, TN 37215.

Author Contributions: Conception and design: E.J. Chow, B.A. Mueller, D.L. Friedman.

Analysis and interpretation of the data: E.J. Chow, B.A. Mueller, K.S. Baker, K.L. Cushing-Haugen, P.J. Martin, D.L. Friedman, S.J. Lee.

Drafting of the article: E.J. Chow.

Critical revision of the article for important intellectual content: E.J. Chow, B.A. Mueller, K.S. Baker, K.L. Cushing-Haugen, M.E.D. Flowers, P.J. Martin, D.L. Friedman, S.J. Lee.

Final approval of the article: E.J. Chow, B.A. Mueller, K.S. Baker, K.L. Cushing-Haugen, M.E.D. Flowers, P.J. Martin, D.L. Friedman, S.J. Lee.

Provision of study materials or patients: B.A. Mueller, M.E.D. Flowers, P.J. Martin.

Statistical expertise: E.J. Chow.

Obtaining of funding: E.J. Chow, B.A. Mueller, P.J. Martin, D.L. Friedman.

Administrative, technical, or logistic support: B.A. Mueller, M.E.D. Flowers, P.J. Martin.

Collection and assembly of data: E.J. Chow, B.A. Mueller, P.J. Martin, D.L. Friedman.


Ann Intern Med. 2011;155(1):21-32. doi:10.7326/0003-4819-155-1-201107050-00004
Text Size: A A A

Background: Hematopoietic stem cell transplantation (HSCT) is increasingly used to treat multiple malignant and nonmalignant conditions. The risk for cardiovascular disease after the procedure has not been well-described.

Objective: To compare rates and hazards of cardiovascular-related hospitalization and death among persons who were still alive at least 2 years after HSCT with those in a population-based sample.

Design: Retrospective cohort study.

Setting: Comprehensive cancer center.

Patients: 1491 patients who had survived 2 years or longer after HSCT received between 1985 and 2006, and frequency-matched persons who were randomly selected from drivers' license files in the state of Washington.

Measurements: Cardiovascular hospitalizations and death, as determined from statewide hospital discharge records and death registries in Washington.

Results: Compared with the general population, transplant recipients experienced increased cardiovascular death (adjusted incidence rate difference, 3.6 per 1000 person-years [95% CI, 1.7 to 5.5]). Recipients also had an increased cumulative incidence of ischemic heart disease, cardiomyopathy or heart failure, stroke, vascular diseases, and rhythm disorders and an increased incidence of related conditions that predispose toward more serious cardiovascular disease (hypertension, renal disease, dyslipidemia, and diabetes). No consistent differences in hazards were observed after total-body irradiation or receipt of an allogeneic versus an autologous graft, aside from an increased rate of hypertension among recipients of allogeneic grafts. Disease relapse after transplantation was associated with an increased hazard of cardiovascular death (hazard ratio, 2.3 [CI, 1.1 to 4.8]).

Limitation: All patients received HSCT at a single institution, and no information was available on pretransplantation treatment and lifestyle factors that may influence risk for cardiovascular disease.

Conclusion: Increased rates of cardiovascular disease should be taken into account when caring for patients who have received HSCT. Future efforts should be directed toward improved screening and controlling of factors that predispose toward cardiovascular disease.

Primary Funding Source: The American Society for Blood and Marrow Transplantation, the Leukemia and Lymphoma Society, and the Seattle Children's Research Institute.

Figures

Grahic Jump Location
Figure 1.
Cumulative incidence of cardiovascular outcomes.

Data are shown for 1096 HSCT recipients who were matched to 4352 persons in the general population. The log-rank P value was <0.01 for all outcomes. Comp = comparison group; HSCT = hematopoietic stem cell transplant.

Grahic Jump Location
Grahic Jump Location
Figure 2.
Cumulative incidence of related outcomes.

Data are shown for 1096 HSCT recipients who were matched to 4352 persons in the general population. The log-rank P value was <0.01 for all outcomes. Comp = comparison group; HSCT = hematopoietic stem cell transplant.

Grahic Jump Location

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Comments

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Cardiovacular death in HSCT
Posted on July 20, 2011
Sabino Guillermo Echebarria Mendieta
-
Conflict of Interest: None Declared

The practice and current progression in hematopoietic stem-cell transplantationand mesenchymal stem-cell sources have been described in recent literature.The concept of BM origin in certain autoimmune diseases and mobilization of marrow cells by GCSF and possibilities of disease exacerbation , added to the facilities considering ASC ( adipous ) use in vascular disease models or peripheral blood precursors , has been considered in recent guidelines , pros and cons in HSCT. The rfrequency of complications in MS , for example , has been added to death rate between 5 % and 10 % . A related condition is the role of EPC mobilizated in acute cerebrovascular or cardiovascular events. The different subpopulations of EPC showed endothelial markers ( UEA-1 lectin , KDR , vWF ) , related to acute markers in such samples descriptives. Thus , relation between progressio MSC and these markers would be clinical progression pathways in this area.

Ref. Acute EPCs mobilization with greater endothelial differentiation in subacute phase of ischemic stroke. SEN 2008

Conflict of Interest:

None declared

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