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Premature coronary artery disease following allogeneic stem cell transplantation: an NHLBI Cohort Study

Bone Marrow Transplantation volume 54, pages 320–322 (2019)Cite this article

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Recipients of allogeneic hematopoietic cell transplantation (HCT) are now surviving longer due to impressive reductions in early transplant-related mortality [1]. Delayed transplant-related mortality in long-term allogeneic HCT survivors now exceeds relapse-related mortality [2, 3]. For such patients surviving at 2 years, the probability of surviving 10 years beyond HCT is 85% [3]. However, survivors of allogeneic HCT have a threefold higher incidence of arterial events than after autologous HCT [4]. The traditional cardiovascular risk factors (hypertension, dyslipidemia, smoking, diabetes, and obesity) are associated with higher rates of arterial events in these patients and these occur relatively early, at a median age of 53 years [5]. Concurrent chemotherapy, radiation, chronic graft versus host disease, steroids, and other immunosuppressants are believed to modulate these risk factors, through endothelial damage, leading to premature atherosclerosis [4,5,6,7].

We created a prediction risk stratification model that incorporated specific risk factors associated with allogeneic HCT, using coronary stenosis as measured using cardiac computed tomography angiography (CCTA) to determine the presence of coronary artery disease (CAD). CCTA is a low-risk, non-invasive and highly sensitive diagnostic tool to assess coronary atherosclerotic burden [8, 9].

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Authors and Affiliations

  1. NHLBI, National Institutes of Health, Hematology Branch, 10 Center Drive MSC, Bethesda, MD, 20892, USA

    Kimberley Doucette, Upneet Chawla, Natasha A. Jain, Sawa Ito, Eleftheria Koklanaris, John Barrett & Minoo Battiwalla

  2. Office of Biostatistics Research, NHLBI, National Institutes of Health, 6701 Rockledge Dr RKL2/9208, Bethesda, MD, 20892-7913, USA

    Xin Tian

  3. NHLBI, National Institutes of Health, Cardiopulmonary Branch, 10 Center Drive MSC 1202, Bethesda, MD, 20892, USA

    Marcus Chen

  4. Quebec Heart and Lung Institute, Laval University, 2725, Chemin Sainte-Foy, Québec, QC, G1V 4G5, Canada

    Peter Bogaty

Authors
  1. Kimberley Doucette
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  2. Xin Tian
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  3. Upneet Chawla
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  4. Natasha A. Jain
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  5. Marcus Chen
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  6. Sawa Ito
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  7. Peter Bogaty
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  8. Eleftheria Koklanaris
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  9. John Barrett
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  10. Minoo Battiwalla
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Correspondence to Kimberley Doucette.

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The authors declare that they have no conflict of interest.

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Doucette, K., Tian, X., Chawla, U. et al. Premature coronary artery disease following allogeneic stem cell transplantation: an NHLBI Cohort Study. Bone Marrow Transplant 54, 320–322 (2019). https://doi.org/10.1038/s41409-018-0282-6

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