Advances in autologous hematopoietic cell transplantation (HCT) strategies have resulted in a growing number of long-term survivors. However, these survivors are at increased risk of developing cardiovascular complications due to pre-HCT therapeutic exposures and conditioning and post-HCT comorbidities. We examined the incidence and predictors of congestive heart failure (CHF) in 1244 patients undergoing autologous HCT for a hematologic malignancy between 1988 and 2002. The cumulative incidence of CHF was 4.8% at 5 years and increased to 9.1% at 15 years after transplantation; the CI for female lymphoma survivors was 14.5% at 15 years. The cohort was at a 4.5-fold increased risk of CHF (standardized incidence ratio = 4.5), compared with the general population. The risk of CHF increased substantially for patients receiving ≥ 250 mg/m2 of cumulative anthracycline exposure (odds ratio [OR]: 9.9, P < .01), creating a new and lower threshold for cardiac surveillance after HCT. The presence of hypertension among recipients of high-dose anthracycline (≥ 250 mg/m2) resulted in a 35-fold risk (OR: 35.3, P < .01) of CHF; the risk was nearly 27-fold (OR: 26.8, P < .01) for high-dose anthracycline recipients with diabetes, providing evidence that hypertension and diabetes may be critical modifiers of anthracycline-related myocardial injury after HCT and creating targeted populations for aggressive intervention.
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机译:自体造血细胞移植(HCT)策略的进展已导致越来越多的长期存活者。但是,由于HCT之前的治疗暴露和条件以及HCT之后的合并症,这些幸存者罹患心血管并发症的风险增加。我们检查了1988年至2002年之间因血液系统恶性肿瘤而接受自体HCT的1244例患者的充血性心力衰竭(CHF)的发生率和预测因素。CHF的累积发生率在5年时为4.8%,在移植后15年时增至9.1%。 15年女性淋巴瘤幸存者的CI为14.5%。与普通人群相比,该人群的CHF风险增加了4.5倍(标准发生率= 4.5)。接受≥250 mg / m 2 sup>蒽环类药物累积暴露的患者发生CHF的风险显着增加(几率[OR]:9.9,P <.01),为心脏监护创造了一个新的更低的阈值在HCT之后。大剂量蒽环类药物(≥250 mg / m 2 sup>)接受者出现高血压会导致CHF发生风险高35倍(OR:35.3,P <.01)。高剂量蒽环类药物糖尿病患者的风险约为27倍(OR:26.8,P <.01),这提供了证据表明高血压和糖尿病可能是HCT后蒽环类药物相关的心肌损伤的关键调节因素,并为攻击性人群提供了目标人群介入。
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