Late cardiovascular events after allogeneic hematopoietic stem cell transplantation: a retrospective multicenter study of the Late Effects Working Party of the European Group for Blood and Marrow Transplantation.
BACKGROUND
Long-term outcome after hematopoietic stem cell transplantation including late transplant-related events is of increasing interest. The aim of this study was to evaluate the incidence of cardiovascular events after allogeneic HSCT and to search for their risk factors.


METHODS
This is a retrospective multicenter European Group of Blood and Marrow Transplantation (EBMT) analysis, including 548 long-term survivors treated in ten EBMT transplant centers, who underwent hematopoietic stem cell transplantation between 1990 and 1995 and survived >or=1 year after the transplant. All arterial events occurring after hematopoietic stem cell transplantation (cerebral, coronary, peripheral) were reported.


RESULTS
Twenty (3.6%) out of 548 patients had a cardiovascular event in at least one arterial territory. The median age at occurrence of cardiovascular events was 54 years (range, 41-70). The cumulative incidence of a first arterial event 15 years after hematopoietic stem cell transplantation was 6% (95% CI, 3%-10%). The cumulative incidence for patients with a high global cardiovascular risk score, defined as having >or=50% of the risk factors (arterial hypertension, diabetes, dys-lipidemia, increased body-mass index, physical inactivity, smoking) was 17%, as compared to 4% in those with a low risk score. In multivariate analysis age older than 30 years at last follow-up, and a high global cardiovascular risk score were associated with, respectively, 6.4-fold and 9.8-fold increases in the risk of an arterial event.


CONCLUSIONS
Long-term survivors after allogeneic hematopoietic stem cell transplantation are likely to have an increased risk of premature cardiovascular accidents.
Department of Hematology, University Hospital, CH 4031-Basel, Switzerland. tichelli@datacomm.ch
André
A
Tichelli
Jakob
J
Passweg
Dorota
D
Wójcik
Alicia
A
Rovó
Jean-Luc
JL
Harousseau
Tamas
T
Masszi
Axel
A
Zander
Albert
A
Békássy
Charles
C
Crawley
Mutlu
M
Arat
Simona
S
Sica
Patrick
P
Lutz
Gérard
G
Socié
D000328:Adult; D000368:Aged; D001157:Arterial Occlusive Diseases / Q000453:epidemiology / Q000209:etiology; D001803:Blood Transfusion; D016026:Bone Marrow Transplantation / Q000009:adverse effects; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000209:etiology; D003327:Coronary Disease / Q000453:epidemiology; D005500:Follow-Up Studies; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects* / Q000401:mortality; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D016491:Peripheral Vascular Diseases / Q000453:epidemiology; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D015996:Survival Rate; D017741:Survivors; D013997:Time Factors