Incidence and predictors of congestive heart failure after autologous hematopoietic cell transplantation.

Abstract

Advances in autologous hematopoietic cell transplantation (HCT) strategies have resulted in a growing number of long-term survivors. However, these survivors are at increased risk of developing cardiovascular complications due to pre-HCT therapeutic exposures and conditioning and post-HCT comorbidities. We examined the incidence and predictors of congestive heart failure (CHF) in 1244 patients undergoing autologous HCT for a hematologic malignancy between 1988 and 2002. The cumulative incidence of CHF was 4.8% at 5 years and increased to 9.1% at 15 years after transplantation; the CI for female lymphoma survivors was 14.5% at 15 years. The cohort was at a 4.5-fold increased risk of CHF (standardized incidence ratio = 4.5), compared with the general population. The risk of CHF increased substantially for patients receiving ≥ 250 mg/m(2) of cumulative anthracycline exposure (odds ratio [OR]: 9.9, P < .01), creating a new and lower threshold for cardiac surveillance after HCT. The presence of hypertension among recipients of high-dose anthracycline (≥ 250 mg/m(2)) resulted in a 35-fold risk (OR: 35.3, P < .01) of CHF; the risk was nearly 27-fold (OR: 26.8, P < .01) for high-dose anthracycline recipients with diabetes, providing evidence that hypertension and diabetes may be critical modifiers of anthracycline-related myocardial injury after HCT and creating targeted populations for aggressive intervention.

• Authors: Saro H Armenian, Can-Lan Sun, Tabitha Shannon, George Mills, Liton Francisco, Kalyanasundaram Venkataraman, F Lennie Wong, Stephen J Forman, Smita Bhatia
• Journal: Blood (Blood) Vol. 118 Issue 23 Pg. 6023-9 (Dec 01 2011) ISSN: 1528-0020 [Electronic] United States
• PMID: 21976673 (Publication Type: Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)

Chemical References

• Anthracyclines

Topics

• Adolescent
• Adult
• Aged
• Anthracyclines (therapeutic use)
• Case-Control Studies
• Comorbidity
• Female
• Heart Failure (mortality)
• Hematologic Neoplasms (mortality, therapy)
• Hematopoietic Stem Cell Transplantation (mortality)
• Humans
• Hypertension (mortality)
• Incidence
• Male
• Middle Aged
• Predictive Value of Tests
• Risk Factors
• Sex Distribution
• Survival Analysis
• Transplantation, Autologous
• Young Adult