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Cardiovascular risk assessment and management of patients undergoing hematopoietic cell transplantation

Bone Marrow Transplantation volume 56, pages 544–551 (2021)Cite this article

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Abstract

The purpose of this review is to provide a framework for the cardiovascular evaluation and management of patients undergoing hematopoietic cell transplantation (HCT). To accomplish this, we have performed an extensive literature review, critically analyzed the available evidence, and developed a set of recommendations to guide best practice. Herein, we discuss the cardiovascular risk profile of patients undergoing HCT along with putative mechanisms of HCT-induced cardiovascular injury. We then present an algorithm for cardiovascular testing and risk mitigation of potential recipients. Last, we address the management of the most prevalent cardiovascular conditions associated with HCT recipients.

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Fig. 1: Practical risk stratification for hematopoetic stem cell transplantation patients.

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References

  1. Gratwohl A, Baldomero H, Aljurf M, Pasquini MC, Bouzas LF, Yoshimi A, et al. Hematopoietic stem cell transplantation A global perspective. JAMA. 2010;303:1617–24. https://doi.org/10.1001/jama.2010.491.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Majhail NS, Tao L, Bredeson C, Davies S, Dehn J, Gajewski JL, et al. Prevalence of hematopoietic cell transplant survivors in the United States. Biol Blood Marrow Transpl. 2013;19:1498–501. https://doi.org/10.1016/j.bbmt.2013.07.020.

    Article  Google Scholar 

  3. D’Souza A, Fretham C. Current Uses and Outcomes of Hematopoietic Cell Transplantation (HCT): CIBMTR Summary Slides 2018. Available at: https://www.cibtmr.org. Accessed 21 Jan 2020.

  4. Passweg JR, Baldomero H, Gratwohl A, Bregni M, Cesaro S, Dreger P, et al. The EBMT activity survey: 1990–2010. Bone Marrow Transpl. 2012;47:906–23. https://doi.org/10.1038/bmt.2012.66. e-pub ahead of print 2012/05/01.

    Article  CAS  Google Scholar 

  5. Epperla N, Hamadani M, Horowitz MM Indications for allogeneic hematopoietic stem cell transplantation in adults. In: Establishing a hematopoietic stem cell transplantation unit. Springer, Cham, Switzerland, 2018, pp 83–109.

  6. Graff TM, Singavi AK, Schmidt W, Eastwood D, Drobyski WR, Horowitz M, et al. Safety of outpatient autologous hematopoietic cell transplantation for multiple myeloma and lymphoma. Bone Marrow Transpl. 2015;50:947–53. https://doi.org/10.1038/bmt.2015.46. e-pub ahead of print 04/13.

    Article  CAS  Google Scholar 

  7. Shah N, Cornelison AM, Saliba R, Ahmed S, Nieto YL, Bashir Q, et al. Inpatient vs outpatient autologous hematopoietic stem cell transplantation for multiple myeloma. Eur J Haematol. 2017;99:532–5. https://doi.org/10.1111/ejh.12970. e-pub ahead of print 10/08.

    Article  CAS  PubMed  Google Scholar 

  8. Nivison-Smith I, Simpson JM, Dodds AJ, Ma DDF, Szer J, Bradstock KF. Relative survival of long-term hematopoietic cell transplant recipients approaches general population rates. Biol Blood Marrow Transpl. 2009;15:1323–30. https://doi.org/10.1016/j.bbmt.2009.06.014.

    Article  Google Scholar 

  9. Vanderwalde AM, Sun CL, Laddaran L, Francisco L, Armenian S, Berano-Teh J, et al. Conditional survival and cause-specific mortality after autologous hematopoietic cell transplantation for hematological malignancies. Leukemia. 2013;27:1139–45. https://doi.org/10.1038/leu.2012.311.

    Article  CAS  PubMed  Google Scholar 

  10. Bhatia S, Francisco L, Carter A, Sun CL, Baker KS, Gurney JG, et al. Late mortality after allogeneic hematopoietic cell transplantation and functional status of long-term survivors: report from the bone marrow transplant survivor study. Blood. 2007;110:3784–92. https://doi.org/10.1182/blood-2007-03-082933.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Martin PJ, Counts GW Jr, Appelbaum FR, Lee SJ, Sanders JE, Deeg HJ, et al. Life expectancy in patients surviving more than 5 years after hematopoietic cell transplantation. J Clin Oncol. 2010;28:1011–6. https://doi.org/10.1200/JCO.2009.25.6693.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Tichelli A, Bhatia S, Socie G. Cardiac and cardiovascular consequences after haematopoietic stem cell transplantation. Br J Haematol. 2008;142:11–26. https://doi.org/10.1111/j.1365-2141.2008.07165.x.

    Article  PubMed  Google Scholar 

  13. Blaes A, Konety S, Hurley P. Cardiovascular complications of hematopoietic stem cell transplantation. Curr Treat Options Cardiovasc Med. 2016;18:25. https://doi.org/10.1007/s11936-016-0447-9. e-pub ahead of print 2016/02/26.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Armenian SH, Sun CL, Vase T, Ness KK, Blum E, Francisco L, et al. Cardiovascular risk factors in hematopoietic cell transplantation survivors: role in development of subsequent cardiovascular disease. Blood. 2012;120:4505–12. https://doi.org/10.1182/blood-2012-06-437178.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Tichelli A, Rovo A, Passweg J, Schwarze CP, Van Lint MT, Arat M, et al. Late complications after hematopoietic stem cell transplantation. Expert Rev Hematol. 2009;2:583–601. https://doi.org/10.1586/ehm.09.48.

    Article  PubMed  Google Scholar 

  16. Armenian SH, Hudson MM, Mulder RL, Chen MH, Constine LS, Dwyer M, et al. Recommendations for cardiomyopathy surveillance for survivors of childhood cancer: a report from the International Late Effects of Childhood Cancer Guideline Harmonization Group. Lancet Oncol. 2015;16:e123–36. https://doi.org/10.1016/S1470-2045(14)70409-7. e-pub ahead of print 2015/03/11.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Group CsO. Long‐term follow‐up guidelines for survivors of childhood, adolescent, and young adult cancers, Version 4.0. Monrovia, CA: Children’s Oncology Group; 2013. This guideline provides a very thorough approach to the monitoring of risks associated with cancer and its treatment, particular to children, adolescents and young adults 2017.

    Google Scholar 

  18. Khayata M, Al-Kindi S, Njoroge L, De Lima MJG, Oliveira GH. Preexisting cardiovascular disease in patients undergoing hematopoietic stem cell transplantation. J Clin Oncol. 2018;36:e19501. https://doi.org/10.1200/JCO.2018.36.15_suppl.e19501.

    Article  Google Scholar 

  19. Cardinale D, Colombo A, Sandri MT, Lamantia G, Colombo N, Civelli M, et al. Prevention of high-dose chemotherapy-induced cardiotoxicity in high-risk patients by angiotensin-converting enzyme inhibition. Circulation. 2006;114:2474–81. https://doi.org/10.1161/CIRCULATIONAHA.106.635144.

    Article  CAS  PubMed  Google Scholar 

  20. Chow EJ, Mueller BA, Baker KS, Cushing-Haugen KL, Flowers ME, Martin PJ, et al. Cardiovascular hospitalizations and mortality among recipients of hematopoietic stem cell transplantation. Ann Intern Med. 2011;155:21–32. https://doi.org/10.7326/0003-4819-155-1-201107050-00004. e-pub ahead of print 2011/07/06.

    Article  PubMed  Google Scholar 

  21. Armenian SH, Sun C-L, Vase T, Ness KK, Blum E, Francisco L, et al. Cardiovascular risk factors in hematopoietic cell transplantation survivors: role in development of subsequent cardiovascular disease. Blood, J Am Soc Hematol. 2012;120:4505–12.

    Article  CAS  Google Scholar 

  22. Armenian SH, Yang D, Teh JB, Atencio LC, Gonzales A, Wong FL, et al. Prediction of cardiovascular disease among hematopoietic cell transplantation survivors. Blood Adv. 2018;2:1756–64. https://doi.org/10.1182/bloodadvances.2018019117. e-pub ahead of print 2018/07/25.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Armenian SH, Sun CL, Mills G, Teh JB, Francisco L, Durand JB, et al. Predictors of late cardiovascular complications in survivors of hematopoietic cell transplantation. Biol Blood Marrow Transpl. 2010;16:1138–44. https://doi.org/10.1016/j.bbmt.2010.02.021.

    Article  CAS  Google Scholar 

  24. Premstaller M, Perren M, Koçack K, Arranto C, Favre G, Lohri A, et al. Dyslipidemia and lipid-lowering treatment in a hematopoietic stem cell transplant cohort: 25 years of follow-up data. J Clin Lipido. 2018;12:464–.e463. https://doi.org/10.1016/j.jacl.2017.11.008. e-pub ahead of print 12/06.

    Article  Google Scholar 

  25. Peres E, Levine JE, Khaled YA, Ibrahim RB, Braun TM, Krijanovski OI, et al. Cardiac complications in patients undergoing a reduced-intensity conditioning hematopoietic stem cell transplantation. Bone Marrow Transpl. 2010;45:149–52. https://doi.org/10.1038/bmt.2009.97.

    Article  CAS  Google Scholar 

  26. Tonorezos ES, Stillwell EE, Calloway JJ, Glew T, Wessler JD, Rebolledo BJ, et al. Arrhythmias in the setting of hematopoietic cell transplants. Bone Marrow Transpl. 2015;50:1212–6. https://doi.org/10.1038/bmt.2015.127. e-pub ahead of print 2015/06/01.

    Article  CAS  Google Scholar 

  27. Cardinale D, Sandri MT, Colombo A, Colombo N, Boeri M, Lamantia G, et al. Prognostic value of troponin I in cardiac risk stratification of cancer patients undergoing high-dose chemotherapy. Circulation. 2004;109:2749–54. https://doi.org/10.1161/01.CIR.0000130926.51766.CC.

    Article  CAS  PubMed  Google Scholar 

  28. Cardinale D, Sandri MT, Martinoni A, Tricca A, Civelli M, Lamantia G, et al. Left ventricular dysfunction predicted by early troponin I release after high-dose chemotherapy. J Am Coll Cardiol. 2000;36:517–22.

    Article  CAS  Google Scholar 

  29. Snowden JA, Hill GR, Hunt P, Carnoutsos S, Spearing RL, Espiner E, et al. Assessment of cardiotoxicity during haemopoietic stem cell transplantation with plasma brain natriuretic peptide. Bone Marrow Transpl. 2000;26:309–13. https://doi.org/10.1038/sj.bmt.1702507.

    Article  CAS  Google Scholar 

  30. Leger KJ, Baker KS, Cushing-Haugen KL, Flowers MED, Leisenring WM, Martin PJ, et al. Lifestyle factors and subsequent ischemic heart disease risk after hematopoietic cell transplantation. Cancer. 2018;124:1507–15. https://doi.org/10.1002/cncr.31227.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Felker GM, Thompson RE, Hare JM, Hruban RH, Clemetson DE, Howard DL, et al. Underlying causes and long-term survival in patients with initially unexplained cardiomyopathy. N Engl J Med. 2000;342:1077–84. https://doi.org/10.1056/NEJM200004133421502.

    Article  CAS  PubMed  Google Scholar 

  32. Chung T, Lim WC, Sy R, Cunningham I, Trotman J, Kritharides L. Subacute cardiac toxicity following autologous haematopoietic stem cell transplantation in patients with normal cardiac function. Heart (Br Card Soc). 2008;94:911–8. https://doi.org/10.1136/hrt.2007.123299. e-pub ahead of print 2007/12/12.

    Article  CAS  Google Scholar 

  33. Murdych T, Weisdorf DJ. Serious cardiac complications during bone marrow transplantation at the University of Minnesota, 1977-1997. Bone Marrow Transpl. 2001;28:283–7. https://doi.org/10.1038/sj.bmt.1703133.

    Article  CAS  Google Scholar 

  34. Blaser BW, Kim HT, Alyea EP, Ho VT, Cutler C, Armand P, et al. Hyperlipidemia and Statin Use after Allogeneic Hematopoietic Stem Cell Transplantation. Biol Blood Marrow Transpl. 2012;18:575–83. https://doi.org/10.1016/j.bbmt.2011.08.003.

    Article  CAS  Google Scholar 

  35. Rackley C, Schultz KR, Goldman FD, Chan KW, Serrano A, Hulse JE, et al. Cardiac manifestations of graft-versus-host disease. Biol Blood Marrow Transpl. 2005;11:773–80. https://doi.org/10.1016/j.bbmt.2005.07.002.

    Article  Google Scholar 

  36. Ando M, Yokozawa T, Sawada J, Takaue Y, Togitani K, Kawahigashi N, et al. Cardiac conduction abnormalities in patients with breast cancer undergoing high-dose chemotherapy and stem cell transplantation. Bone Marrow Transpl. 2000;25:185–9. https://doi.org/10.1038/sj.bmt.1702106.

    Article  CAS  Google Scholar 

  37. Akahori M, Nakamae H, Hino M, Yamane T, Hayashi T, Ohta K, et al. Electrocardiogram is very useful for predicting acute heart failure following myeloablative chemotherapy with hematopoietic stem cell transplantation rescue. Bone Marrow Transpl. 2003;31:585–90.

    Article  CAS  Google Scholar 

  38. Poudel SK, de Lima M, Metheny L. Posttransplant maintenance therapy for acute leukemias. Curr Opin Hematol. 2019;26:96–111.

    Article  Google Scholar 

  39. Chen Y-B, McCarthy PL, Hahn T, Holstein SA, Ueda M, Kröger N, et al. Methods to prevent and treat relapse after hematopoietic stem cell transplantation with tyrosine kinase inhibitors, immunomodulating drugs, deacetylase inhibitors, and hypomethylating agents. Bone Marrow Transpl. 2019;54:497–507.

    Article  CAS  Google Scholar 

  40. Sandri MT, Salvatici M, Cardinale D, Zorzino L, Passerini R, Lentati P, et al. N-terminal pro-B-type natriuretic peptide after high-dose chemotherapy: a marker predictive of cardiac dysfunction? Clin Chem. 2005;51:1405–10. https://doi.org/10.1373/clinchem.2005.050153.

    Article  CAS  PubMed  Google Scholar 

  41. Fujimaki K, Maruta A, Yoshida M, Sakai R, Tanabe J, Koharazawa H, et al. Severe cardiac toxicity in hematological stem cell transplantation: predictive value of reduced left ventricular ejection fraction. Bone Marrow Transpl. 2001;27:307–10. https://doi.org/10.1038/sj.bmt.1702783. e-pub ahead of print 2001/03/30.

    Article  CAS  Google Scholar 

  42. Thavendiranathan P, Poulin F, Lim KD, Plana JC, Woo A, Marwick TH. Use of myocardial strain imaging by echocardiography for the early detection of cardiotoxicity in patients during and after cancer chemotherapy - a systematic review. J Am College Cardiology. 2014. https://doi.org/10.1016/j.jacc.2014.01.073.

  43. Koyama J, Falk RH. Prognostic significance of strain Doppler imaging in light-chain amyloidosis. JACC: Cardiovascular Imaging. 2010;3:333–42.

    PubMed  Google Scholar 

  44. Tong J, Laport G, Lowsky R. Rhabdomyolysis after concomitant use of cyclosporine and simvastatin in a patient transplanted for multiple myeloma. Bone Marrow Transpl. 2005;36:739–40. https://doi.org/10.1038/sj.bmt.1705128.

    Article  CAS  Google Scholar 

  45. Shimabukuro-Vornhagen A, Glossmann J, Liebig T, Scheid C, Bergwelt-Baildon MV. The use of statins in hematopoietic stem cell transplantation. Curr Stem Cell Res Ther. 2009;4:260–5.

    Article  CAS  Google Scholar 

  46. Tang WH, Thomas S, Kalaycio M, Sobecks R, Andresen S, Jarvis J, et al. Clinical outcomes of patients with impaired left ventricular ejection fraction undergoing autologous bone marrow transplantation: can we safely transplant patients with impaired ejection fraction? Bone Marrow Transpl. 2004;34:603–7. https://doi.org/10.1038/sj.bmt.1704610. e-pub ahead of print 2004/07/20.

    Article  CAS  Google Scholar 

  47. Sakata-Yanagimoto M, Kanda Y, Nakagawa M, Asano-Mori Y, Kandabashi K, Izutsu K, et al. Predictors for severe cardiac complications after hematopoietic stem cell transplantation. Bone Marrow Transpl. 2004;33:1043–7. https://doi.org/10.1038/sj.bmt.1704487.

    Article  CAS  Google Scholar 

  48. Hurley P, Konety S, Cao Q, Weisdorf D, Blaes A. Hematopoietic stem cell transplantation in patients with systolic dysfunction: Can it be Done? Biol Blood Marrow Transpl. 2014. https://doi.org/10.1016/j.bbmt.2014.10.011.

  49. Al-Kindi S, Younes A, Qattan M, Oliveira G. Preemptive cardioprotective strategies in patients receiving chemotherapy. Curr Cardiovasc Risk Rep. 2014;8:1–14. https://doi.org/10.1007/s12170-014-0406-5.

    Article  Google Scholar 

  50. Bosch X, Sitges M, Rovira M, Ortiz-Perez JT, Esteve J. Reply: enalapril and carvedilol for preventing chemotherapy-induced left ventricular systolic dysfunction in patients with malignant hemopathies. J Am Coll Cardiol. 2013;62:2452. https://doi.org/10.1016/j.jacc.2013.08.712.

    Article  PubMed  Google Scholar 

  51. Stillwell EE, Wessler JD, Rebolledo BJ, Steingart RM, Petrlik EL, Jakubowski AA, et al. Retrospective outcome data for hematopoietic stem cell transplantation in patients with concurrent coronary artery disease. Biol Blood Marrow Transplant. 2011;17:1182–6. https://doi.org/10.1016/j.bbmt.2010.12.698.

    Article  PubMed  Google Scholar 

  52. Qazilbash MH, Amjad AI, Qureshi S, Qureshi SR, Saliba RM, Khan ZU, et al. Outcome of allogeneic hematopoietic stem cell transplantation in patients with low left ventricular ejection fraction. Biol Blood Marrow Transplant. 2009;15:1265–70.

    Article  Google Scholar 

  53. Ying Z, Xu X, Bai Y, Zhong J, Chen M, Liang Y, et al. Long-term exposure to concentrated ambient PM2. 5 increases mouse blood pressure through abnormal activation of the sympathetic nervous system: a role for hypothalamic inflammation. Environ Health Perspect. 2013;122:79–86.

    Article  Google Scholar 

  54. Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE, Colvin MM, et al. 2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America. Circulation. 2017;136:e137–61. https://doi.org/10.1161/CIR.0000000000000509.

    Article  PubMed  Google Scholar 

  55. Bosch X, Rovira M, Sitges M, Domènech A, Ortiz-Pérez JT, de Caralt TM, et al. Enalapril and carvedilol for preventing chemotherapy-induced left ventricular systolic dysfunction in patients with malignant hemopathies: the OVERCOME trial (preventiOn of left Ventricular dysfunction with Enalapril and caRvedilol in patients submitted to intensive ChemOtherapy for the treatment of Malignant hEmopathies). J Am Coll Cardiol. 2013;61:2355–62.

    Article  CAS  Google Scholar 

  56. Guha A, Dey AK, Jneid H, Ibarz JP, Addison D, Fradley M. Atrial Fibrillation in the Era of Emerging Cancer Therapies. Eur Heart J. 2019;40:36:3007–10.

  57. January CT, Wann LS, Calkins H, Chen LY, Cigarroa JE, Cleveland JC, et al. 2019 AHA/ACC/HRS focused update of the 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol. 2019;74:104–32.

    Article  Google Scholar 

  58. Marrouche NF, Brachmann J, Andresen D, Siebels J, Boersma L, Jordaens L, et al. Catheter ablation for atrial fibrillation with heart failure. N Engl J Med. 2018;378:417–27.

    Article  Google Scholar 

  59. Reddy VY, Holmes D, Doshi SK, Neuzil P, Kar S. Safety of percutaneous left atrial appendage closure: results from the Watchman Left Atrial Appendage System for Embolic Protection in Patients with AF (PROTECT AF) clinical trial and the Continued Access Registry. Circulation. 2011;123:417–24.

    Article  Google Scholar 

  60. Singla A, Hogan WJ, Ansell SM, Buadi FK, Dingli D, Dispenzieri A, et al. Incidence of supraventricular arrhythmias during autologous peripheral blood stem cell transplantation. Biol Blood Marrow Transpl. 2013;19:1233–7. https://doi.org/10.1016/j.bbmt.2013.05.019. e-pub ahead of print 2013/06/06.

    Article  Google Scholar 

  61. Sidana S, Sidiqi MH, Dispenzieri A, Buadi FK, Lacy MQ, Muchtar E, et al. Fifteen year overall survival rates after autologous stem cell transplantation for AL amyloidosis. Am J Hematol. 2019;94:1020–6. https://doi.org/10.1002/ajh.25566.

    Article  CAS  PubMed  Google Scholar 

  62. Sidiqi MH, Aljama MA, Buadi FK, Warsame RM, Lacy MQ, Dispenzieri A, et al. Stem cell transplantation for light chain amyloidosis: decreased early mortality over time. J Clin Oncol. 2018;36:1323–9.

    Article  Google Scholar 

  63. Al Saleh AS, Sidiqi MH, Muchtar E, Dispenzieri A, Buadi FK, Dingli D, et al. Outcomes of patients with light chain amyloidosis who had autologous stem cell transplantation with 3 or more organs involved. Biol Blood Marrow Transpl. 2019;25:1520–5. https://doi.org/10.1016/j.bbmt.2019.04.024. e-pub ahead of print 2019/05/06.

    Article  Google Scholar 

  64. https://static1.squarespace.com/static/5b44f08ac258b493a25098a3/t/5d7fd7bd27708631a437368f/1568659390030/Amyloid+mSMART+8-8-2019+Rx.pdf [Internet]. 2019. Accessed 21 January, 2020.

  65. Gertz MA, Lacy MQ, Dispenzieri A, Gastineau DA, Chen MG, Ansell SM, et al. Stem cell transplantation for the management of primary systemic amyloidosis. Am J Med. 2002;113:549–55. https://doi.org/10.1016/s0002-9343(02)01208-1. e-pub ahead of print 2002/12/03.

    Article  CAS  PubMed  Google Scholar 

  66. Goldsmith YB, Liu J, Chou J, Hoffman J, Comenzo RL, Steingart RM. Frequencies and types of arrhythmias in patients with systemic light-chain amyloidosis with cardiac involvement undergoing stem cell transplantation on telemetry monitoring. Am J Cardiol. 2009;104:990–4.

    Article  Google Scholar 

  67. Covi S, Ravindranath Y, Farooqi A, Savasan S, Chu R, Aggarwal S. Changes in Bi-ventricular function after hematopoietic stem cell transplant as assessed by speckle tracking echocardiography. Pediatr Cardiol. 2018;39:365–74. https://doi.org/10.1007/s00246-017-1764-9. e-pub ahead of print 11/01.

    Article  PubMed  Google Scholar 

  68. Poręba M, Gać P, Usnarska-Zubkiewicz L, Pilecki W, Kuliczkowski K, Mazur G, et al. Evaluation of the impact of treatment with hematopoietic stem cells transplantation (HSCT) on biochemical markers of heart function and novel electrocardiographic markers of repolarization in patients with hematological malignancies. Med Oncol. 2018;35:162. https://doi.org/10.1007/s12032-018-1221-5.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  69. Roziakova L, Bojtarova E, Mistrik M, Dubrava J, Gergel J, Lenkova N, et al. Serial measurements of cardiac biomarkers in patients after allogeneic hematopoietic stem cell transplantation. J Exp Clin Cancer Res. 2012;31:13. https://doi.org/10.1186/1756-9966-31-13.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  70. Jain NA, Chen MY, Shanbhag S, Lu K, Pophali PA, Ito S, et al. Contrast enhanced cardiac CT reveals coronary artery disease in 45% of asymptomatic allo-SCT long-term survivors. Bone Marrow Transpl. 2014;49:451–2. https://doi.org/10.1038/bmt.2013.182. e-pub ahead of print 11/18.

    Article  CAS  Google Scholar 

  71. Andersen R, Wethal T, Günther A, Fosså A, Edvardsen T, Fosså SD, et al. Relation of coronary artery calcium score to premature coronary artery disease in survivors >15 years of Hodgkin’s lymphoma. Am J Cardiol. 2010;105:149–52.

    Article  Google Scholar 

  72. Griffith ML, Savani BN, Boord JB. Dyslipidemia after allogeneic hematopoietic stem cell transplantation: evaluation and management. Blood J Am Soc Hematol. 2010;116:1197–204.

    CAS  Google Scholar 

  73. Baker KS, Ness KK, Steinberger J, Carter A, Francisco L, Burns LJ, et al. Diabetes, hypertension, and cardiovascular events in survivors of hematopoietic cell transplantation: a report from the bone marrow transplantation survivor study. Blood. 2007;109:1765–72. https://doi.org/10.1182/blood-2006-05-022335.

    Article  CAS  PubMed  Google Scholar 

  74. Griffith ML, Jagasia M, Jagasia SM. Diabetes mellitus after hematopoietic stem cell transplantation. Endocr Pr. 2010;16:699–706. https://doi.org/10.4158/EP10027.RA.

    Article  Google Scholar 

  75. Kuittinen T, Jantunen E, Vanninen E, Mussalo H, Vuolteenaho O, Ala-Kopsala M, et al. Cardiac effects within 3 months of BEAC high-dose therapy in non-Hodgkin’s lymphoma patients undergoing autologous stem cell transplantation. Eur J Haematol. 2006;77:120–7. https://doi.org/10.1111/j.1600-0609.2006.00687.x.

    Article  CAS  PubMed  Google Scholar 

  76. Dhesi S, Chu MP, Blevins G, Paterson I, Larratt L, Oudit GY, et al. Cyclophosphamide-induced cardiomyopathy: a case report, review, and recommendations for management. J Investigative Med High Impact Case Rep. 2013;1:2324709613480346.

    Google Scholar 

  77. Nieto Y, Cagnoni PJ, Bearman SI, Shpall EJ, Matthes S, Jones RB. Cardiac toxicity following high-dose cyclophosphamide, cisplatin, and BCNU (STAMP-I) for breast cancer. Biol Blood Marrow Transpl. 2000;6:198–203. https://doi.org/10.1016/s1083-8791(00)70043-7. e-pub ahead of print 2000/05/18.

    Article  CAS  Google Scholar 

  78. Brockstein BE, Smiley C, Al-Sadir J, Williams SF. Cardiac and pulmonary toxicity in patients undergoing high-dose chemotherapy for lymphoma and breast cancer: prognostic factors. Bone Marrow Transpl. 2000;25:885–94. https://doi.org/10.1038/sj.bmt.1702234. e-pub ahead of print 2000/05/16.

    Article  CAS  Google Scholar 

  79. Cooper LT, Baughman KL, Feldman AM, Frustaci A, Jessup M, Kuhl U, et al. The role of endomyocardial biopsy in the management of cardiovascular disease: a scientific statement from the American Heart Association, the American College of Cardiology, and the European Society of Cardiology. Endorsed by the Heart Failure Society of America and the Heart Failure Association of the European Society of Cardiology. J Am Coll Cardiol. 2007;50:1914–31. https://doi.org/10.1016/j.jacc.2007.09.008. e-pub ahead of print 2007/11/06.

    Article  PubMed  Google Scholar 

  80. Gul Z, Bashir Q, Cremer M, Yusuf SW, Gunaydin H, Arora S et al. Short-term cardiac toxicity of autologous hematopoietic stem cell transplant for multiple myeloma. Leukemia lymphoma 2014: 1-3. https://doi.org/10.3109/10428194.2014.926346. e-pub ahead of print 2014/06/03.

  81. Phillips GL, Meisenberg B, Reece DE, Adams VR, Badros A, Brunner J, et al. Amifostine and autologous hematopoietic stem cell support of escalating-dose melphalan: a phase I study. Biol Blood Marrow Transpl. 2004;10:473–83. https://doi.org/10.1016/j.bbmt.2004.03.001. e-pub ahead of print 2004/06/19.

    Article  CAS  Google Scholar 

  82. Ritchie DS, Seymour JF, Roberts AW, Szer J, Grigg AP. Acute left ventricular failure following melphalan and fludarabine conditioning. Bone Marrow Transpl. 2001;28:101–3. https://doi.org/10.1038/sj.bmt.1703098. e-pub ahead of print 2001/08/11.

    Article  CAS  Google Scholar 

  83. Gul Z, Bashir Q, Cremer M, Yusuf SW, Gunaydin H, Arora S et al. Short-term cardiac toxicity of autologous hematopoietic stem cell transplant for multiple myeloma. Leukemia lymphoma; 0:1-3. https://doi.org/10.3109/10428194.2014.926346.

  84. Shoji S, Miyakita H, Shima M, Usui Y, Nagata Y, Uchida T, et al. Acute myocardial infarction during combined chemotherapy with bleomycin, etoposide and cisplatin for testicular cancer. Hinyokika kiyo Acta urologica Japonica. 2006;52:723–6.

    PubMed  Google Scholar 

  85. Kawano N, Yamaguchi K, Niki T, Yamamoto T, Iwase T, Taketani Y, et al. Two cases of acute myocardial infarction during combined chemotherapy in young patients with testicular cancer. J Cardiol Cases. 2013;7:e176–80. https://doi.org/10.1016/j.jccase.2013.02.009.

    Article  PubMed  PubMed Central  Google Scholar 

  86. Patel AA, Mainardi A, Varma M, Sara G. Cytarabine induced pericardial tamponade. Blood. 2011;118:4298. https://doi.org/10.1182/blood.V118.21.4298.4298.

    Article  Google Scholar 

  87. Case Report: Cytarabine-Induced Pericarditis and Pericardial Effusion. The Medicine Forum, 2017.

  88. Cil T, Kaplan MA, Altintas A, Pasa S, Isikdogan A. Cytosine-arabinoside induced bradycardia in patient with non-Hodgkin lymphoma: a case report. Leuk lymphoma. 2007;48:1247–9. https://doi.org/10.1080/10428190701332456.

    Article  PubMed  Google Scholar 

  89. Pai VB, Nahata MC. Cardiotoxicity of chemotherapeutic agents: incidence, treatment and prevention. Drug Saf. 2000;22:263–302.

    Article  CAS  Google Scholar 

  90. Genet P, Pulik M, Gallet B, Lionnet F, Jondeau K, Touahri T, et al. Acute myocardial ischemia after high-dose therapy with BEAM regimen. Bone Marrow Transpl. 2002;30:253–4. https://doi.org/10.1038/sj.bmt.1703632. e-pub ahead of print 2002/08/31.

    Article  CAS  Google Scholar 

  91. Newbery G, Lima NA, Gurgel LA, Driscoll R, Lima CCV. Persistent heart failure following melphalan and fludarabine conditioning. J Cardiol Cases. 2019;20:88–91. https://doi.org/10.1016/j.jccase.2019.05.001. e-pub ahead of print 2019/09/10.

    Article  PubMed  PubMed Central  Google Scholar 

  92. Morandi P, Ruffini PA, Benvenuto GM, Raimondi R, Fosser V. Cardiac toxicity of high-dose chemotherapy. Bone Marrow Transpl. 2005;35:323–34. https://doi.org/10.1038/sj.bmt.1704763. e-pub ahead of print 2004/11/16.

    Article  CAS  Google Scholar 

  93. Henes JC, Koetter I, Horger M, Schmalzing M, Mueller K, Eick C, et al. Autologous stem cell transplantation with thiotepa-based conditioning in patients with systemic sclerosis and cardiac manifestations. Rheumatology. 2014;53:919–22. https://doi.org/10.1093/rheumatology/ket464.

    Article  CAS  PubMed  Google Scholar 

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Author notes

  1. These authors contributed equally: Guilherme H. Oliveira, Sadeer G. Al-Kindi

Authors and Affiliations

  1. Heart and Vascular Institute, University of South Florida, Tampa General Hospital and Moffitt Cancer Center, Tampa, FL, USA

    Guilherme H. Oliveira

  2. University Hospitals Cleveland Medical Center, Cleveland, OH, USA

    Sadeer G. Al-Kindi & Avirup Guha

  3. Department of Medicine, Case Western Reserve University, Cleveland, OH, USA

    Sadeer G. Al-Kindi, Avirup Guha & Marcos J. deLima

  4. National Heart, Lung and Blood Institute, Bethesda, MD, USA

    Amit K. Dey

  5. Division of Cardiovascular Diseases, University of Tennessee Health Science Center, Memphis, TN, USA

    Isaac B. Rhea

  6. Stem Cell Transplant Program, Seidman Cancer Center, Cleveland, OH, USA

    Marcos J. deLima

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  1. Guilherme H. Oliveira
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Oliveira, G.H., Al-Kindi, S.G., Guha, A. et al. Cardiovascular risk assessment and management of patients undergoing hematopoietic cell transplantation. Bone Marrow Transplant 56, 544–551 (2021). https://doi.org/10.1038/s41409-020-01080-1

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  • DOI: https://doi.org/10.1038/s41409-020-01080-1

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