Increased risk of cardio-cerebrovascular disease after hematopoietic cell transplantation in patients with previous history.
Chin Med J (Engl)
; 134(12): 1431-1440, 2021 Jun 04.
Article
en En
| MEDLINE
| ID: mdl-34091525
ABSTRACT
BACKGROUND:
The impacts of previous cardio-cerebrovascular disease (pre-CCVD) on the outcomes of hematopoietic cell transplantation (HCT) are not well described. Patients with pre-CCVD may often be poor candidates for HCT. This study aimed to investigate the impact of pre-CCVD on transplant outcomes.METHODS:
A retrospective study was conducted between patients with and without pre-CCVD who consecutively received allogeneic or autologous HCT between November 2013 and January 2020 with a matching of age and disease status. The cardiovascular complications and HCT outcomes of the two groups were evaluated and compared. The primary endpoints were post-transplant cardio-cerebrovascular disease (post-CCVD) and non-relapse mortality (NRM). We used a multivariable Cox proportional hazard model and the Fine-Gray competing risk regressions for analyses to estimate the hazard ratios (HRs).RESULTS:
The outcomes of 23 HCT recipients with pre-CCVD were compared with those of 107 patients in the control group. No significant differences were noted in terms of engraftment, overall survival (OS) (67.00% vs. 67.90%, Pâ=â0.983), or relapse (29.78% vs. 28.26%, Pâ=â0.561) between the pre-CCVD group and the control group. The cumulative incidences of 2-year NRM were similar between patients with pre-CCVD and the controls (14.68% vs. 17.08%, Pâ=â0.670). However, pre-CCVD was associated with an increased incidence of post-CCVD (HR 12.50, 95% confidence interval [CI] 3.88-40.30, Pâ<â0.001), which was an independent risk factor for increased NRM (HR 10.29, 95% CI 3.84-27.62, Pâ<â0.001) and inferior OS (HR 10.29, 95% CI 3.84-27.62, Pâ<â0.001).CONCLUSIONS:
These findings suggest that the existence of pre-CCVD before transplantation might not result in increased mortality directly but superpose the toxicity of the transplantation procedure, leading to a risk of post-CCVD. Post-CCVD was a powerful predictor for high NRM and inferior OS. Further risk stratification of pre-CCVD is needed to reduce NRM in various transplantation settings.
Texto completo:
1
Colección:
01-internacional
Banco de datos:
MEDLINE
Asunto principal:
Trastornos Cerebrovasculares
/
Trasplante de Células Madre Hematopoyéticas
Tipo de estudio:
Etiology_studies
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Límite:
Humans
Idioma:
En
Revista:
Chin Med J (Engl)
Año:
2021
Tipo del documento:
Article
País de afiliación:
China