ABSTRACT
Metabolic syndrome (MetS) is a constellation of cardiovascular risk factors that increases the risk of cardiovascular disease, diabetes mellitus and all cause mortality. Long-term survivors of hematopoietic cell transplantation (HCT) have a substantial risk of developing MetS and cardiovascular disease, with the estimated prevalence of MetS being 31-49% among HCT recipients. Although MetS has not yet been proven to impact cardiovascular risk after HCT, an understanding of the incidence and risk factors for MetS in HCT recipients can provide the foundation to evaluate screening guidelines and develop interventions that may mitigate cardiovascular-related mortality. A working group was established through the Center for International Blood and Marrow Transplant Research and the European Group for Blood and Marrow Transplantation with the goal of reviewing literature and recommend practices appropriate to HCT recipients. Here we deliver consensus recommendations to help clinicians provide screening and preventive care for MetS and cardiovascular disease among HCT recipients. All HCT survivors should be advised of the risks of MetS and encouraged to undergo recommended screening based on their predisposition and ongoing risk factors.
Subject(s)
Cardiovascular Diseases , Hematopoietic Stem Cell Transplantation/adverse effects , Metabolic Syndrome , Allografts , Cardiovascular Diseases/etiology , Cardiovascular Diseases/prevention & control , Humans , Metabolic Syndrome/etiology , Metabolic Syndrome/prevention & control , Practice Guidelines as TopicSubject(s)
Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Neoplasms, Germ Cell and Embryonal/drug therapy , Neoplasms, Germ Cell and Embryonal/therapy , Transplantation, Autologous/methods , Adult , Female , Humans , Male , Middle Aged , Neoplasms, Germ Cell and Embryonal/pathology , Young AdultSubject(s)
B-Lymphocytes , Breast Neoplasms , Graft vs Host Disease , Leukemia, Myeloid, Acute , Monitoring, Physiologic , Peripheral Blood Stem Cell Transplantation , Rituximab/administration & dosage , Adult , Allografts , Breast Neoplasms/blood , Breast Neoplasms/therapy , Female , Graft vs Host Disease/blood , Graft vs Host Disease/drug therapy , Humans , Leukemia, Myeloid, Acute/blood , Leukemia, Myeloid, Acute/therapyABSTRACT
Hematopoietic stem cell transplant (HCT) recipients have a substantial risk of developing secondary solid cancers, particularly beyond 5 years after HCT and without reaching a plateau overtime. A working group was established through the Center for International Blood and Marrow Transplant Research and the European Group for Blood and Marrow Transplantation with the goal to facilitate implementation of cancer screening appropriate to HCT recipients. The working group reviewed guidelines and methods for cancer screening applicable to the general population and reviewed the incidence and risk factors for secondary cancers after HCT. A consensus approach was used to establish recommendations for individual secondary cancers. The most common sites include oral cavity, skin, breast and thyroid. Risks of cancers are increased after HCT compared with the general population in skin, thyroid, oral cavity, esophagus, liver, nervous system, bone and connective tissues. Myeloablative TBI, young age at HCT, chronic GVHD and prolonged immunosuppressive treatment beyond 24 months were well-documented risk factors for many types of secondary cancers. All HCT recipients should be advised of the risks of secondary cancers annually and encouraged to undergo recommended screening based on their predisposition. Here we propose guidelines to help clinicians in providing screening and preventive care for secondary cancers among HCT recipients.
