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Blood, 1 November 2007, Vol. 110, No. 9, pp. 3463-3471.
Prepublished online as a Blood First Edition Paper on July 30, 2007; DOI 10.1182/blood-2006-10-054080.
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Submitted October 24, 2006
Accepted July 16, 2007
Premature cardiovascular disease after allogeneic stem cell transplantation
Andre Tichelli*, Christoph Bucher, Alicia Rovo, Georg Stussi, Martin Stern, Michael Paulussen, Jorg Halter, Sandrine Meyer-Monard, Dominik Heim, Dimitrios A Tsakiris, Barbara Biedermann, Jakob R Passweg, and Alois Gratwohl
Division of Hematology, University Hospital, Basel, Switzerland
Pediatric Hematolgy / Oncology, University Children's Hospital (UKBB), Basel, Switzerland
Department of Research, University Hospital, Basel, Switzerland
* Corresponding author; email: tichelli{at}datacomm.ch.
We assessed incidence and risk factors of cardiovascular events in 265 patients undergoing allogeneic hematopoietic stem cell transplantation (HSCT) between 1980-2000 and who survived  2 years. Results were compared to a cohort of 145 patients treated during the same period with autologous HSCT. The median age of patients with allogeneic HSCT at last follow-up was 39 years, median follow-up was 9 years. Eighteen (6.8%) patients after allogeneic, and 3 (2.1%) patients after autologous HSCT experienced an arterial event. The cumulative incidence of first arterial event after allogeneic HSCT was 22.1% [95%CI, 12.0-40.9] at 25 years. The cumulative incidence 15 years after allogeneic HSCT was 7.5% as compared to 2.3% after autologous HSCT. Adjusting for age, risk of an arterial event was significantly higher after allogeneic HSCT (RR 6.92; P=0.0093). In multivariate analysis, allogeneic HSCT (RR: 14.5; P=0.003) and 2 of 4 cardiovascular risk factors (hypertension, dyslipidemia, diabetes, obesity) (RR: 12.4; P=0.02) were associated with a higher incidence of arterial events after HSCT. Thus, long term survivors after allogeneic HSCT are at high risk for premature arterial vascular disease. HSCT might favor the emergence of established risk factor, such as hypertension, diabetes and dyslipidemia.
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