Predictors of late cardiovascular complications in survivors of hematopoietic cell transplantation.
Predictors of late cardiovascular complications in survivors of hematopoietic cell transplantation.
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DOI：
10.1016/j.bbmt.2010.02.021
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发表时间：
2010-08
影响因子：
4.3
通讯作者：
Bhatia, Smita
中科院分区：
文献类型：
--
作者：
Armenian, Saro H.;Sun, Can-Lan;Mills, George;Teh, Jennifer Berano;Francisco, Liton;Durand, Jean-Bernard;Wong, F. Lennie;Forman, Stephen J.;Bhatia, Smita
造血细胞移植(HCT)后的长期存活现在是一个预期的结果。越来越多的幸存者面临着发生与治疗相关的并发症的风险，包括心血管事件(CVD)。采用嵌套式病例对照设计，确定临床和治疗相关的危险因素与晚期(HCT后1年以上)CVD的发生有关。病例是从1977年至2006年期间在希望之城移植的一年多幸存者队列中确定的。对照组(无心血管疾病的同种异体移植幸存者)在年龄、同种异体移植的年份、同种异体同种异体移植的类型和随访时间上进行匹配。63例晚期CVD患者中，44例(69.8%)为冠状动脉事件，19例(30.2%)为脑血管事件。HCT的中位年龄为49.0岁；晚期CVD的中位年龄为54.0岁；66.7%的患者接受过自体HCT。多因素Logistic回归分析显示，多个心血管危险因素(≥2如下：肥胖、血脂异常、高血压和糖尿病)与HCT后晚期心血管疾病风险增加5.2倍相关(p<；0.0 1)；HCT前胸部放疗与冠状动脉疾病风险9.5倍相关(p=0.0 3)。HCT前暴露于胸部辐射和存在合并症是HCT后晚期CVD相关风险的主要原因。这些数据构成了开发预测模型的基础，用于识别高危个体，以进行有针对性的监测和积极管理合并症。
Long-term survival after hematopoietic cell transplantation (HCT) is now an expected outcome. The growing population of survivors is at risk of developing treatment-related complications, including cardiovascular events (CVD). A nested case-control design was used to identify clinical and treatment-related risk factors for development of late (1+ years after HCT) CVD. Cases were identified from a cohort of one+ year survivors transplanted at City of Hope between 1977 and 2006. Controls (HCT survivors without CVD) were matched on age, year of HCT, type of HCT, and length of follow-up. Sixty-three patients with late CVD were identified; 44 (69.8%) with coronary artery events, and 19 (30.2%) with cerebrovascular events. Median age at HCT was 49.0 years; median age at late CVD was 54.0 years; 66.7% had undergone autologous HCT. Multivariate logistic regression analysis revealed multiple cardiovascular risk factors (≥2 of the following: obesity, dyslipidemia, hypertension, and diabetes) after HCT to be associated with a 5.2-fold increased risk of late CVD (p<0.01); pre-HCT chest radiation was associated with a 9.5-fold risk of coronary artery disease (p=0.03). Pre-HCT exposure to chest radiation and presence of comorbidities are primarily responsible for the risk associated with late CVD after HCT. These data form the basis for developing predictive models for identifying high-risk individuals for targeted surveillance and aggressive management of comorbidities.
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