Cardiovascular Disease after Hematopoietic Stem Cell Transplantation in Adults (JACC: CardioOncology State-of-the-Art Review August 2024)-Article: Cardiovascular Disease after Hematopoietic Stem Cell Transplantation in Adults

Article: Cardiovascular Disease after Hematopoietic Stem Cell Transplantation in Adults

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Hematopoietic stem cell transplantation (HCT), used to treat various malignant and nonmalignant conditions, has seen increased application over the past four decades. This procedure now includes older individuals with more comorbidities, resulting in a higher cardiovascular risk post-transplant. Cardiovascular issues post-HCT include atrial arrhythmias, heart failure, myocardial infarction, and pericardial effusions. These risks differ based on the type of transplant (autologous or allogeneic), conditioning therapies involved, and patient-specific factors.<br /><br />**Key Points:**<br /><br />1. **Cardiotoxic Factors**: Therapies used in HCT can be cardiotoxic, with risks such as arrhythmias and heart failure being common. Conditioning therapies, post-transplant cyclophosphamide, and drugs for graft-versus-host disease (GVHD) prophylaxis are notable contributors.<br />  <br />2. **Short- and Long-term Complications**: Short-term cardiovascular issues are relatively rare but have significant long-term incidence, notably heart failure and myocardial infarction, particularly in allogeneic HCT recipients. GVHD and earlier treatments like anthracycline use add to cardiovascular risks.<br /><br />3. **Risk Assessment Before HCT**: Patients should undergo a comprehensive cardiovascular assessment, including history, clinical examination, echocardiography or cardiac magnetic resonance imaging (CMR), and electrocardiography. Tools like the hematopoietic cell transplantation comorbidity index (HCT-CI) and the CARE-BMT score can aid in risk stratification.<br /><br />4. **Management**: Cardiovascular toxicities should be managed using general guidelines due to a lack of specific prospective data. Exercise interventions before and after HCT are beneficial for reducing long-term cardiovascular risk and improving overall fitness.<br /><br />5. **Surveillance**: A structured follow-up plan, especially for high-risk patients, involving periodic cardiovascular risk assessment and echocardiograms, is crucial. Early detection and management of cardiovascular risk factors such as hypertension, diabetes, and dyslipidemia are recommended.<br /><br />6. **Implications**: Ongoing research is essential to improve risk prediction tools and define optimal strategies for monitoring and treating cardiovascular complications in HCT patients, tailored to individual patient risk profiles.<br /><br />Overall, comprehensive cardiovascular care, including prehabilitation, risk assessment, and continuous monitoring, is critical for improving outcomes in patients undergoing HCT.

Keywords

Hematopoietic stem cell transplantation

cardiovascular risk

atrial arrhythmias

heart failure

myocardial infarction

conditioning therapies

graft-versus-host disease

risk assessment

cardiotoxic factors

surveillance