ESPEYB16 9. Oncology and Chronic Disease Metabolic and Cardiovascular Risk in Cancer Survivors (6 abstracts)
9.6. Late cardiovascular morbidity and mortality following pediatric allogeneic hematopoietic cell transplantation
Duncan CN , Brazauskas R , Huang J , Shaw BE , Majhail NS , Savani BN , Flowers MED , Battiwalla M , Beebe K , Dietz AC , Dvorak CC , Giller R , Jacobsohn DA , Kletzel M , Martin PL , Nemecek ER , Nuechterlein B , Talano JA , Pulsipher MA & Baker KS
To read the full abstract: Bone Marrow Transplant. 2018 Oct; 53 (10):1278
Early cardiovascular disease is relatively common among childhood cancer survivors (CCS). A high risk of accelerated atherosclerosis and a 8.2-fold higher cardiac mortality rate have been reported (1). Arterial stiffness, an independent risk factor for cardiovascular morbidity and mortality in adults, seems to increase in young adult CCS (2). In hematopoietic cell transplantation (HCT) survivors, the risk of cardiovascular death is 2–4 fold higher than the general population, and cardiovascular adverse events occur earlier than average (3).
This multicenter, retrospective study recorded cardiovascular outcomes in 661 long-term survivors of paediatric allogenic HCT for hematologic malignancies. A low cumulative incidence of these outcomes was found: coronary artery disease 0.2%, cerebrovascular accident 0.6%, cardiomyopathy 3%, cardiac-related death 0.5%. Patients who received anthracycline chemotherapy and cranial or chest radiation showed higher risks. Overweight/obesity was present in 52% of patients at last follow up; diabetes requiring medications in 7% and dyslipidemia in 18% of survivors.
The low incidence of adverse events is comforting, but should be interpreted in the light of the patients’ young age (median age 18.5 years at last follow-up) and the relatively short follow up duration (median 8 years, range 2–19). Lipid measurements were missing in a large proportion of patients, suggesting the lack of a regular monitoring and uniformity in clinical practice between centers. The study population included patients aged 21 years or less at the time of transplant who survived, relapse-free at least 2 years following the first allogenic HCT for hematologic malignancy between 1 January 1995 and 31 December 2008. Standards of care radically changed during the 13-year study window, with a progressive increase in the attention on specific metabolic risks of HCT patients.
The main strength of the study is certainly its size that makes it the largest study currently available on cardio-metabolic outcomes following HCT in childhood. Its limitations include the retrospective design, the lack of uniformity in standards of care during the study window, the potential underestimation of the true incidence of diabetes and/or hypertension (having considered only patients who required drugs), and the use of BMI as the only index of overweight/obesity, which does not provide information on body composition alterations in these patients.
References: 1. Mertens AC1, Yasui Y, Neglia JP, Potter JD, Nesbit ME Jr, Ruccione K, Smithson WA, Robison LL. Late mortality experience in five-year survivors of childhood and adolescent cancer: the Childhood Cancer Survivor Study. J Clin Oncol. 2001; 19: 3163–3172.
2. Krystal JI, Reppucci M, Mayr T, Fish JD, Sethna C. Arterial stiffness in childhood cancer survivors. Pediatr Blood Cancer. 2015; 62: 1832–1837.
3. Armenian SH, Chow EJ. Cardiovascular disease in survivors of hematopoietic cell transplantation. Cancer. 2014; 120: 469–479.
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ESPE Yearbook of Paediatric Endocrinology
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