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Originally published as JCO Early Release 10.1200/JCO.2008.17.7428 on September 22 2008 © 2008 American Society of Clinical Oncology. Late Congestive Heart Failure After Hematopoietic Cell Transplantation
From the Division of Hematology/Oncology, Childrens Hospital Los Angeles; Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles; Divisions of Population Sciences and Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA; and the Division of Pediatric Cardiology, University of Minnesota, Minneapolis, MN Corresponding author: Smita Bhatia, MD, MPH, City of Hope Cancer Center, 1500 East Duarte Rd, Duarte, CA 91010-3000; e-mail: sbhatia{at}coh.org Purpose To examine the independent roles of pre–hematopoietic cell transplantation (HCT) therapeutic exposures, transplantation-related conditioning, and comorbidities (pre- and post-HCT) in the development of late congestive heart failure (CHF) after HCT.
Methods This was a nested case-control design. Individuals with late CHF (diagnosed
Results Sixty patients with late CHF were identified; median age at HCT was 45.3 years (range, 16.6 to 68.6 years); median time to CHF was 3.0 years (range, 1.03 to 18.9 years); 68% received autologous HCT. Median ejection fraction was 36.9% (range, 15% to 53%). Compared with matched controls (n = 166), patients with late CHF received more cycles of pre-HCT chemotherapy (8.6 v 4.9 cycles; P < .01), had greater body mass index at HCT (28.4 v 26.2 kg/m2; P = .01), greater lifetime anthracycline exposure (285.3 v 175.6 mg/m2; P < .01), and were more likely to have multiple chronic comorbidities (30.0% v 13.9%; P < .01). Multivariable analysis revealed number of pre-HCT chemotherapy cycles (odds ratio [OR] = 1.2; P < .01), anthracycline dose Conclusion Pre-HCT exposure to anthracyclines and presence of comorbidities are primarily responsible for the risk associated with late CHF after HCT. Conditioning-related therapeutic exposure does not contribute significantly to the risk. These results form the basis for identifying high-risk individuals for targeted surveillance, as well as developing preventive strategies in the form of aggressive management of comorbidities. published online ahead of print at www.jco.org on September 22, 2008 Supported by National Institutes of Health Grants No. R01 CA078938 (S.B.) and P01 CA30206 (S.J.F.), Lymphoma/Leukemia Society Scholar Award for Clinical Research Grant No. 2191-02 (S.B.), and Childrens Hospital Los Angeles Research Career Development Fellowship (S.H.A.). Presented in part at the 44th Annual Meeting of the American Society of Clinical Oncology (Clinical Science Symposium: Treatment-Related Cardiovascular Disease in Survivors of Pediatric and Adult Cancers), May 30-June 3, 2008, Chicago, IL. Authors’ disclosures of potential conflicts of interest and author contributions are found at the end of this article.
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Copyright © 2008 by the American Society of Clinical Oncology, Online ISSN: 1527-7755. Print ISSN: 0732-183X
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1 year after HCT) were identified from a cohort of 2,938 1+ year survivors who underwent transplantation at City of Hope National Medical Center, Duarte, CA. This cohort formed the sampling frame for selecting controls (without CHF) matched for age and year of HCT, donor source (allogeneic v autologous), and length of follow-up. 
