Incidence and predictors of congestive heart failure after autologous hematopoietic cell transplantation
Incidence and predictors of congestive heart failure after autologous hematopoietic cell transplantation
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DOI：
10.1182/blood-2011-06-358226
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发表时间：
2011-12-01
期刊：
影响因子：
20.3
通讯作者：
Bhatia, Smita
中科院分区：
文献类型：
--
作者：
Armenian, Saro H.;Sun, Can-Lan;Bhatia, Smita
自体造血细胞移植（HCT）策略的进步导致了越来越多的长期存活者。然而，由于HCT前治疗暴露和调节以及HCT后合并症，这些幸存者发生心血管并发症的风险增加。我们研究了1988年至2002年间1244例接受自体HCT治疗恶性血液病的患者中充血性心力衰竭（CHF）的发生率和预测因素。CHF的累积发生率在5年时为4.8%，在移植后15年时增加至9.1%;女性淋巴瘤存活者在15年时的CI为14.5%。与一般人群相比，该队列CHF风险增加4.5倍（标准化发病率比= 4.5）。蒽环类抗生素累积暴露量≥ 250 mg/m2的患者CHF风险显著增加（比值比[OR]：9.9，P <0.01），这为HCT后心脏监测创造了一个新的、更低的阈值。大剂量蒽环类药物治疗后高血压的发生（>= 250 mg/m2）导致35倍的风险（OR：35.3，P < .01）;风险接近27倍（或：26.8，P <0.01）对于糖尿病高剂量蒽环类药物接受者，提供证据表明，高血压和糖尿病可能是HCT后蒽环类药物相关心肌损伤的关键修饰剂，并为积极干预创造目标人群。（血。2011;118（23）：6023-6029）
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. (Blood. 2011;118(23):6023-6029)