Heart failure after allogeneic hematopoietic stem cell transplantation.
BACKGROUND
Heart failure (HF) occurring after allogeneic hematopoietic stem cell transplantation (allo-HSCT) is rare but severe. We examine the role of pre-HSCT therapeutic exposures, conditioning regimens, pre-HSCT comorbidities, severe transplant-related complications, and post-HSCT cardiovascular risk factors in the development of heart failure after allo-HSCT.


METHODS
A nested case-control study was designed. Cases with HF and controls matched for age, year of allo-HSCT, and length of follow-up were identified from a cohort of 2455 patients who underwent allo-HSCT between 2000 and 2011 for hematologic malignancies.


RESULTS
Forty-two patients suffered from HF; mean age at presentation was 35 years (± 14 years) and mean time to presentation was 5 months (± 9 months) post-HSCT. The number of pre-HSCT cycles of chemotherapy was significantly greater (7 vs. 5 courses, P=0.023). Cases were significantly more likely to have severe acute GVHD (≥ grade III), hemorrhagic cystitis (≥ grade 2), and multiple severe transplant-related complications compared with controls (42.9% vs. 20.4%, P=0.008). Multivariate analysis revealed that pre-HSCT cycles of chemotherapy of ≥ 5 courses (OR=3.5, P=0.003) and two or more severe transplant-related complications (OR=3.6, P=0.003) were independently associated with HF.


CONCLUSIONS
These results identify the individuals who are at higher risk of developing HF after allo-HSCT. We should pay more attention to these patients and more active management would be reasonable.
Peking University People's Hospital & Institute of Hematology, Beijing Key laboratory of Hematopoitic Stem Cell Transplantation, No 11, South Street of Xizhimen Beijing 100044, PR China.
Xiao-Dong
XD
Mo
Lan-Ping
LP
Xu
Dai-Hong
DH
Liu
Xiao-Hui
XH
Zhang
Huan
H
Chen
Yu-Hong
YH
Chen
Wei
W
Han
Yu
Y
Wang
Feng-Rong
FR
Wang
Jing-Zhi
JZ
Wang
Ting
T
Zhao
Chen-Hua
CH
Yan
Yu-Qian
YQ
Sun
Kai-Yan
KY
Liu
Xiao-Jun
XJ
Huang
D000328:Adult; D016022:Case-Control Studies; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006086:Graft vs Host Disease / Q000175:diagnosis / Q000453:epidemiology; D006333:Heart Failure / Q000175:diagnosis* / Q000453:epidemiology*; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects* / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis* / Q000453:epidemiology*; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D055815:Young Adult