MyHeart

  • Home
  • About Us
    • Our Team
    • Authors
  • Resources
    • MitraClip University
      • Advanced Steering
    • POTS Center
    • Heart Healthy Nutrition
    • MyHeart Videos
  • Articles
  • Podcasts
  • Contact Us
  • Advertising
Home / Featured Articles / Late Cardiac Effects After Stem Cell or Bone Marrow Transplants
Woman after surgery

Late Cardiac Effects After Stem Cell or Bone Marrow Transplants

April 5, 2022 by Alain Bouchard, MD Leave a Comment

This article was written in collaboration with Drs. Wendy Bottinor from VCU Health, Richmond, Virginia, and Carrie Lenneman from UAB School of Medicine in Birmingham, Alabama.

Approximately 1 million stem cell or bone marrow transplants are performed worldwide. In the US, 20,000 stem cell transplants (SCT) are performed each year for hematological malignancies such as leukemia or lymphoma. The most common form of transplant is the allogeneic SCT (60% of cases) and involves the transplantation of donor-derived stem cells for the treatment of non-malignant pediatric conditions such as immune deficiencies, hemoglobinopathies, and metabolic diseases. The other form of transplant is the autologous SCT (40%), most common in adults with lymphoma or multiple myeloma and involves using the patient’s own stem cells.

How Does a Stem Cell or Bone Marrow Transplant Work?

A stem cell transplant accomplishes disease eradication through a high dose of chemotherapy and radiation, leading to ablation of the patient’s bone marrow. This phase of treatment is called “conditioning”. This is followed by the transplantation of either the donor-derived stem cells (allogeneic) or the patient-derived stem cells (autologous) which have been harvested prior to conditioning.

What Are the Risks Associated with Stem Cell or Bone Marrow Transplant?

Besides the risk of relapse of cancer, SCT remains associated with significant early and late treatment-related mortality. Infections, direct toxic effects of the chemotherapy, and, in allogeneic SCT only, graft-vs-host disease remains the main cause of death.

Over the last decade, transplant teams across the world have managed to reduce all-cause, early and late, mortality after autologous SCT. In allogeneic SCT, they were successful in reducing graft-vs-host disease and infections early after transplant, but the late mortality remains high. Advanced disease stage at the time of transplant, increasing age of the recipient, and co-morbid medical conditions remain associated with increased morbidity and mortality.

What Are the Late Cardiovascular Effects of Stem Cell or Bone Marrow Transplant?

Cardiovascular disease in pediatric patients is relatively rare. In a study of 661 children undergoing allogeneic SCT and who survived 2 years, stroke occurred in 0.6%, cardiomyopathy in 0.3%, and cardiac mortality in 0.5%. Risk factors included anthracycline treatment, cranial and chest radiation, diabetes mellitus, and hyperlipidemia. Another study of 161 children who survived 5 years after SCT demonstrated the presence of cardiomyopathy in 26%. As in adults, total body irradiation (TBI) and anthracycline were the major risk factors.

Survivors treated with TBI tend to have increased central adiposity (which may not always be correlated with BMI). TBI exposure also has been strongly associated with subsequent dyslipidemia and impaired glucose intolerance with a greater risk of developing diabetes mellitus and metabolic syndrome. Separate from TBI, any abdominal radiation also has been associated with an increased risk of diabetes. The presence of untreated endocrinopathies such as growth hormone deficiency, hypothyroidism, and hypogonadism can further exacerbate these comorbidities.

Compared to non-transplanted childhood survivors, SCT survivors have been shown to have a substantially increased burden of serious chronic conditions and impairments involving virtually every organ system and overall quality of life. This likely reflects the joint contributions of pre-transplant treatment exposures and organ dysfunction, the transplant conditioning regimen, and any post-transplant graft-vs-host disease. In a study of 1244 patients with autologous SCT, the 5-year incidence of heart failure was 5%, rising to 9% at 15 years.

Cardiovascular injury occurs commonly in children treated with SCT, but the true long-term implications are still unknown. As they enter the stages of adolescence and young adulthood, we need to emphasize primary prevention and aggressive risk factor modification and treat hypertension, hyperlipidemia, diabetes mellitus, obesity, and promote a smoke and vape-free environment.

Adult transplant survivors experience mortality rates higher than the general population, and the risk of premature cardiovascular-related death is increased 2- to 3-fold compared with the general population. Again, aggressive risk factor modification and treatment of comorbidities are imperative.

This article was written in collaboration with Drs. Wendy Bottinor from VCU Health, Richmond, Virginia, and Carrie Lenneman from UAB School of Medicine in Birmingham, Alabama.

5/5 (5)

Tell Us How We're Doing...

Filed Under: Featured Articles, Heart Disease, Risk & Prevention

Leave a Reply Cancel reply

Connect with:
Facebook Google Twitter
If you need immediate medical attention, please call 911. These comments are not guaranteed to be read in a timely manner and should not be used to seek immediate medical advice.

Your email address will not be published. Required fields are marked *

This site uses Akismet to reduce spam. Learn how your comment data is processed.

Alain Bouchard, MD

Dr. Alain Bouchard is a clinical cardiologist at Cardiology Specialists of Birmingham, AL. He is a native of Quebec, Canada and trained in Internal Medicine at McGill University in Montreal. He continued as a Research Fellow at the Montreal Heart Institute. He did a clinical cardiology fellowship at the University of California in San Francisco. He joined the faculty at the University of Alabama Birmingham from 1986 to 1990. He worked at CardiologyPC and Baptist Medical Center at Princeton from 1990-2019. He is now part of the Cardiology Specialists of Birmingham at St. Vincent's Health System, Ascension.

View My Posts

Recent Posts

  • HYPERTENSION, THE SILENT KILLER
  • HDL Conundrum with Dr John J.P. Kastelein
  • THE HDL CHOLESTEROL CONUNDRUM
  • NON-STATIN TREATMENT FOR LDL CHOLESTEROL
  • Non-Statin Treatment for LDL Cholesterol with Dr. John J.P. Kastelein

Categories

  • Aortic disease (7)
  • Featured Articles (70)
  • General Health (39)
    • Complementary Medicine (2)
  • Heart Disease (176)
    • Cardiac Arrhythmias (17)
    • Coronary Artery Disease (51)
    • Heart Failure and Cardiomyopathies (29)
    • Heart Valves (46)
  • Heart Health (116)
    • Diet & Nutrition (36)
    • Exercise (34)
    • Risk & Prevention (54)
  • Medical News (9)
  • Podcast (68)
  • Tests & Investigations (28)
  • Uncategorized (3)
  • Vascular Disease (28)
    • Hypertension (High Blood Pressure) (15)
RECENT POSTS
  • HYPERTENSION, THE SILENT KILLER
  • HDL Conundrum with Dr John J.P. Kastelein
  • THE HDL CHOLESTEROL CONUNDRUM
  • NON-STATIN TREATMENT FOR LDL CHOLESTEROL
  • Non-Statin Treatment for LDL Cholesterol with Dr. John J.P. Kastelein
FOLLOW US
ABOUT MY HEART

MyHeart is a group of physicians dedicated to empowering patients to take control of their health. Read by over a million people every year, MyHeart is quickly becoming a “go to” resource for patients across the world.

POPULAR TOPICS ON MYHEART
  • POTS Syndrome Center
  • Earlobe Crease & Heart Disease
  • Atrial Fibrillation with RVR
  • STEMI
  • MitraClip
  • Mitral Regurgitation
NAVIGATION
  • Home
  • About Us
    • Our Team
    • Authors
  • Resources
    • MitraClip University
      • Advanced Steering
    • POTS Center
    • Heart Healthy Nutrition
    • MyHeart Videos
  • Articles
  • Podcasts
  • Contact Us
  • Advertising

Privacy Policy. Terms of Use.
© 2023 MyHeart. All rights reserved.
MyHeart is not a substitute for advice from a doctor. Read our medical disclaimer. Sitemap.