Long Term Follow-Up Post Allogeneic HSCT
Cardiac

Updated: October 2010

Compared to the general population the risk of late death due to cardiac complications is 2-3 fold higher after allo-HSCT and 4 fold higher in females even after auto-HSCT. There are few studies looking at cardiac late effects in adults. In children the use of TBI and anthracyclines pre-transplant is associated with a 5 year cumulative incidence of cardiac impairment of 26% ( majority asymptomatic). It is highly likely therefore that similar changes would be observed in adults and the true magnitude of these defects will become apparent with longer term studies.

A retrospective EBMT study found a cumulative incidence of arterial event (cerebrovascular/cardiovascular/peripheral arterial) of 6% at 15 years. The CI of an arterial event for patients with a high cardiovascular score (defined as presence of ≥50% of the risk factors including arterial hypertension, diabetes, dyslipidaemia, increased body-mass index, physical inactivity and smoking) was 17%, as compared with 4% in those with a low risk score. The increased incidence has been postulated to be secondary due to endothelial damage provoked by CGVHD and possibly decrease in microvessels. Also, there is an increase in the incidence of cardiovascular risk factors in this patient population.

Recommendations:

• History of cardiac and cardiovascular risk factors since previous visit should be assessed and clinical examinations conducted.
• Life style modification (smoking, weight loss etc) should be recommended.
• Cardiovascular risk factors (HT, DM, Lipids) should be assessed yearly and therapy optimized
• Consider ECHO/ECG at 1year for patients who have received TBI/anthracyclines and base subsequent follow-up on results/symptoms

The information contained in these guidelines is a statement of consensus of Leukemia/BMT Program of BC professionals regarding their views of currently accepted approaches to treatment. Any clinician seeking to apply or consult these documents is expected to use independent medical judgment in the context of individual clinical circumstances to determine any patient’s care or treatment. Use of these guidelines and documents is at your own risk and is subject to the Leukemia/BMT Program of BC’s terms of use available at Terms of Use.