title: 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: Department of Population Sciences, City of Hope, Duarte, CA 91010-3000, USA. sarmenian@coh.org
authors: Saro H
authors: SH
authors: Armenian
authors: Can-Lan
authors: CL
authors: Sun
authors: Tabitha
authors: T
authors: Shannon
authors: George
authors: G
authors: Mills
authors: Liton
authors: L
authors: Francisco
authors: Kalyanasundaram
authors: K
authors: Venkataraman
authors: F Lennie
authors: FL
authors: Wong
authors: Stephen J
authors: SJ
authors: Forman
authors: Smita
authors: S
authors: Bhatia
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D018943:Anthracyclines / Q000627:therapeutic use; D016022:Case-Control Studies; D015897:Comorbidity; D005260:Female; D006333:Heart Failure / Q000401:mortality*; D019337:Hematologic Neoplasms / Q000401:mortality* / Q000628:therapy*; D018380:Hematopoietic Stem Cell Transplantation / Q000401:mortality*; D006801:Humans; D006973:Hypertension / Q000401:mortality; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012307:Risk Factors; D017678:Sex Distribution; D016019:Survival Analysis; D014182:Transplantation, Autologous; D055815:Young Adult
chemical_list: D018943:Anthracyclines