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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

¹ Dept. of Hematology, University Hospital, Basel, Switzerland
² Service d’Hematologie, Hopitaux Universitaires de Genève, Geneva, Switzerland
³ Dept. of Childhood Hematology and Oncology, Wroclaw Medical University, Wroclaw, Poland
⁴ Dept. de Hematologie, Hotel Dieu, Nantes, France
⁵ Dept. of Haematology and Stem Cell Transplant, St. Laszlo Hospital, Budapest, Hungary
⁶ Bone Marrow Transplantation Centre, University Hospital Eppendorf, Hamburg, Germany
⁷ Dept. of Hematology, University Hospital, Lund, Sweden
⁸ Dept. of Hematology, Addenbrookes Hospital, Cambridge, United Kingdom
⁹ Dept. of Hematology, Faculty of Medicine, Ankara University, Ankara, Turkey
¹⁰ Instituto di Ematologia, Universita Cattolica S. Cuore, Rome, Italy
¹¹ Service de Pediatrie Hematologie-Oncologie, Hopital de Hautepierre, Strasbourg, France
¹² Service d’Hematologie, Greffe, Hospital Saint Louis, Paris, France

Correspondence: André Tichelli, Hematology, University Hospital, CH 4031-Basel, Switzerland. E-mail:tichelli{at}datacomm.ch

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.

Design and Methods: This is a retrospective mutlicenter 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 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 occurence 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 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.

Key words: stem cell transplantation, cardiovascular, late effects, long-term survivors.

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