Moderate or severe valvular heart disease and outcomes in allogeneic stem cell transplantation.
Moderate or severe valvular heart disease and outcomes in allogeneic stem cell transplantation.
复制标题
中度或重度瓣膜性心脏病和同种异体干细胞移植的结果。
DOI：
10.1016/j.ijcard.2019.05.032
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发表时间：
2019
影响因子：
3.5
通讯作者：
Sorror,MohamedL
中科院分区：
文献类型：
--
作者：
Brusen,RobinM;Cheng,RichardK;Masri,SophiaC;Leedy,Douglas;Sorror,MohamedL
背景先前开发的造血细胞移植特异性合并症指数（HCT-CI）表明，包括中度或重度瓣膜性心脏病在内的多种合并症是同种异体 HCT 后非复发死亡率的预测因素。然而，缺乏瓣膜疾病对结果影响的详细描述。方法在 2000 年至 2017 年间接受同种异体 HCT 的一大群患者中，我们确定了 21 名患有中度或重度瓣膜疾病的患者。我们还确定了 42 名年龄和 HCT-CI 评分相匹配的对照组。主要结局是全因死亡率，并在随访两年后进行审查。次要结局包括无复发的死亡率、入院持续时间、再入院次数、肌酐和肌钙蛋白峰值增加。结果与对照组相比，非清髓治疗方案在瓣膜疾病队列中更为常见（86% vs 54% p=0.012）。瓣膜病与全因死亡率增加相关，调整后的风险比为 2.17（CI 1.08-4.34，p=0.029），与非复发死亡率增加相关，调整后的风险比为 2.53（CI 1.16-5.52，p=0.020）。在瓣膜疾病组中，与对照组相比，肌酐增加了 1.6 vs 0.9mg/dL (p=0.003)，肌钙蛋白峰值增加了 1.6 vs 0.3ng/mL (p=0.05)。考虑到门诊治疗，再入院或住院时间没有差异。 结论 尽管具有相似的术前危险因素并接受不太积极的化疗方案，但患有中度或以上瓣膜疾病的患者（其中大多数不符合当前的修复指南建议）的非复发相关结局更差，死亡率、肾和心肌损伤更高。
BackgroundA Hematopoietic Cell Transplantation-Specific Comorbidity Index (HCT-CI) was previously developed showing that multiple comorbidities including moderate or greater valvular heart disease to be predictors of non-relapse mortality after allogeneic HCT. However, detailed description of the impact of valve disease on outcomes is lacking.MethodsAmong a large cohort of patients given allogeneic HCT between 2000 and 2017, we identified 21 patients with moderate or severe valvular disease. We also identified a cohort of 42 controls matched on age and HCT-CI score. The primary outcome was all-cause mortality, with censoring at two years of follow-up. Secondary outcomes included mortality without relapse, duration of index admission, number of readmissions, increase in creatinine and peak troponin.ResultsNon-myeloablative regimens were more common in the valve disease cohort compared to controls (86% vs 54% p = 0.012). Valvular disease was associated with increased all-cause mortality with adjusted hazard ratio of 2.17 (CI 1.08–4.34, p = 0.029) and for non-relapse mortality with adjusted hazard ratio of 2.53 (CI 1.16–5.52, p = 0.020). In the valve disease cohort, creatinine increased by 1.6 vs 0.9 mg/dL (p = 0.003) and peak troponin by 1.6 vs 0.3 ng/mL (p = 0.05) compared to controls. There was no difference in readmissions or length of stay when accounting for outpatient treatment.ConclusionsDespite having similar pre-procedure risk factors and undergoing less aggressive chemotherapy regimens, patients with moderate valvular disease or greater, most of whom did not meet current guideline recommendations for repair, had worse non-relapse related outcomes with higher mortality, renal and myocardial injury.