Serious cardiovascular (CV) late effects are uncommon in pediatric transplant survivors, according to a multi-center study of 661 children who underwent hematopoietic cell transplantation (HCT) for hematologic malignancy between 1995 and 2008. Eligible patients (median age 9 years) survived disease-free for a minimum of two years following allogeneic myeloablative HCT and their outcomes were reported to CIBMTR (Center for International Blood and Marrow Transplant Research).
Overall and disease-free survival at 7 years in patients surviving beyond the first 2 years were 94% (95% CI 92-96%) and 89% (95% CI 87-92), respectively. Twenty-eight patients (4.2%) had at least one CV complication, including coronary artery disease/myocardial infarction (1 patient), cerebrovascular accident (4 patients), cardiomyopathy (22 patients), and cardiac-related death (3 patients).
Among patients who survived 2 years disease and CV event free, the cumulative incidence of developing any CV event within the next 5 years was 3% (95% CI 2-4%). Patients who received pre-HCT anthracycline chemotherapy (HR 4.67, p= 0.036), cranial radiation (HR 5.58, p<0.0001), or chest radiation (HR 2.18, p= 0.0087) were at greater risk for developing one CV complication. The researchers noted that although serious late CV complications are uncommon, recipients experienced higher than general population averages of dyslipidemias, diabetes and obesity, which may increase the risk of CV disease over time.