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Long-Term Study Gets to the Heart of Cardiovascular Issues After HSCT

By: Celeste L. Dixon
Posted: Friday, December 8, 2023

In a multicenter observational study involving more than 3,300 adult recipients of autologous or allogeneic hematopoietic stem cell transplantation (HSCT) over 11 years, researchers characterized the incidence of short-term cardiovascular events (within 100 days of transplantation) as relatively low. Long-term cardiovascular events (occurring after 100 days), particularly heart failure, were more common among allogeneic HSCT recipients as well as those with such preexisting cardiovascular comorbidities as a history of smoking and elevated body mass index. Atrial fibrillation or flutter was the most common short- and long-term cardiovascular event, with a 100-day incidence of 2.6% and a 5-year incidence of 6.8%, reported Alexi Vasbinder, PhD, RN, of the University of Michigan, Ann Arbor, and colleagues in JACC CardioOncology. The next most-common event was heart failure, with a 1.1% incidence at 100 days and 5.4% at 5 years.

Of the 2,004 patients who underwent autologous HSCT, 53.3% had multiple myeloma, as did 2.2% of the 1,350 who underwent allogeneic HSCT. Acute myeloid leukemia was the most common diagnosis in the latter cohort, at 44.2%.

All patients were treated between 2008 and 2019 (mean patient age, 55 years; 40.9% female; 30.1% Black) and followed for a median of 2.3 years. According to the chart review, the 100-day and 5-year cumulative incidences of cardiovascular events were 4.1% and 13.9%, respectively. The 5-year incidence of long-term cardiovascular events was 16.4% among allogeneic HSCT recipients compared with 12.1% among autologous HSCT recipients (P = .002).

“These findings highlight the importance of evaluating cardiovascular risk before stem cell transplant and the need for ongoing monitoring for cardiovascular complications in the long term post-transplant,” emphasized Dr. Vasbinder and co-investigators. This is especially true “given the shifting demographics toward an older eligible transplant population with greater age-related comorbidities.” They suggested further research be done to determine the best strategies to prevent and manage such complications.

Disclosure: The study authors reported no conflicts of interest.

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