Increased risk of cardio-cerebrovascular disease after hematopoietic cell transplantation in patients with previous history.
10.1097/CM9.0000000000001569
- Author:
Bo PENG
1
;
Li-Li WANG
1
;
Li-Ping DOU
1
;
Fei LI
1
;
Xiang-Shu JIN
1
;
Lu WANG
1
;
Ming-Yu JIA
1
;
Yan LI
1
;
Jian BO
1
;
Yu ZHAO
1
;
Hai-Yan ZHU
1
;
Wen-Rong HUANG
1
;
Dai-Hong LIU
1
Author Information
1. Department of Hematology, The Fifth Medical Center of Chinese PLA General Hospital, Beijing 100071, China.
- Publication Type:Journal Article
- MeSH:
Cerebrovascular Disorders/etiology*;
Hematopoietic Stem Cell Transplantation/adverse effects*;
Humans;
Proportional Hazards Models;
Retrospective Studies;
Transplantation Conditioning;
Transplantation, Autologous
- From:
Chinese Medical Journal
2021;134(12):1431-1440
- CountryChina
- Language:English
-
Abstract:
BACKGROUND:The impacts of previous cardio-cerebrovascular disease (pre-CCVD) on the outcomes of hematopoietic cell transplantation (HCT) are not well described. Patients with pre-CCVD may often be poor candidates for HCT. This study aimed to investigate the impact of pre-CCVD on transplant outcomes.
METHODS:A retrospective study was conducted between patients with and without pre-CCVD who consecutively received allogeneic or autologous HCT between November 2013 and January 2020 with a matching of age and disease status. The cardiovascular complications and HCT outcomes of the two groups were evaluated and compared. The primary endpoints were post-transplant cardio-cerebrovascular disease (post-CCVD) and non-relapse mortality (NRM). We used a multivariable Cox proportional hazard model and the Fine-Gray competing risk regressions for analyses to estimate the hazard ratios (HRs).
RESULTS:The outcomes of 23 HCT recipients with pre-CCVD were compared with those of 107 patients in the control group. No significant differences were noted in terms of engraftment, overall survival (OS) (67.00% vs. 67.90%, P = 0.983), or relapse (29.78% vs. 28.26%, P = 0.561) between the pre-CCVD group and the control group. The cumulative incidences of 2-year NRM were similar between patients with pre-CCVD and the controls (14.68% vs. 17.08%, P = 0.670). However, pre-CCVD was associated with an increased incidence of post-CCVD (HR: 12.50, 95% confidence interval [CI]: 3.88-40.30, P < 0.001), which was an independent risk factor for increased NRM (HR: 10.29, 95% CI: 3.84-27.62, P < 0.001) and inferior OS (HR: 10.29, 95% CI: 3.84-27.62, P < 0.001).
CONCLUSIONS:These findings suggest that the existence of pre-CCVD before transplantation might not result in increased mortality directly but superpose the toxicity of the transplantation procedure, leading to a risk of post-CCVD. Post-CCVD was a powerful predictor for high NRM and inferior OS. Further risk stratification of pre-CCVD is needed to reduce NRM in various transplantation settings.
