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Armenian SH, Horak D, Scott JM, Mills G, Siyahian A, Berano Teh J, Douglas PS, Forman SJ, Bhatia S, Jones LW. Cardiovascular Function in Long-Term Hematopoietic Cell Transplantation Survivors. Biol Blood Marrow Transplant 2017; 23:700-705. [PMID: 28065839 DOI: 10.1016/j.bbmt.2017.01.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Accepted: 01/02/2017] [Indexed: 12/22/2022]
Abstract
Peak oxygen consumption (VO2peak), as measured by cardiopulmonary exercise testing (CPET), is a powerful independent predictor of cardiovascular disease (CVD) and all-cause mortality in a broad range of populations. We assessed the safety and feasibility of CPET in aging long-term hematopoietic cell transplantation (HCT) survivors, a population at high risk for premature onset of CVD. Next, we examined how organ-specific impairments (eg, cardiac, pulmonary, hematologic) impact VO2peak after HCT. Twenty consecutive HCT survivors underwent a comprehensive assessment of cardiopulmonary health that included CPET, echocardiography with strain, pulmonary function testing, 6-minute walk test, and timed up and go. Median age at assessment was 67.4 years (range, 42 to 75), and median time from HCT was 9.8 years (range, 3 to 20). No adverse events were observed during CPET procedures, and 95% of studies were considered to be at "peak" effort (respiratory exchange ratio ≥ 1.10). VO2peak was on average 22% less than predicted, and allogeneic HCT survivors had markedly lower VO2peak when compared with autologous HCT survivors (18.2 mL/kg/min versus 22.2 mL/kg/min; P = .05). Six participants (30%) had VO2peak ≤ 16 mL/kg/min, a threshold associated with a 9-foldrisk of death in patients undergoing HCT. Despite the presence of normal (>50%) resting left ventricular ejection fraction in all participants, 25% had markedly abnormal left ventricular longitudinal strain, an advanced echocardiographic measure of myocardial dysfunction. These findings highlight the role of stress-based measures and advanced myocardial imaging to characterize CVD risk in HCT survivors, setting the stage for tailored interventions to prevent CVD with its attendant morbidity and mortality.
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Affiliation(s)
- Saro H Armenian
- Department of Population Sciences, City of Hope, Duarte, California.
| | - David Horak
- Pulmonary and Critical Care Medicine, City of Hope, Duarte, California
| | - Jessica M Scott
- University of Texas Medical Branch, NASA Johnson Space Center, Houston, Texas
| | - George Mills
- Department of Population Sciences, City of Hope, Duarte, California
| | - Aida Siyahian
- Department of Population Sciences, City of Hope, Duarte, California
| | | | - Pamela S Douglas
- Duke Clinical Research Institute, Duke University, Durham, North Carolina
| | - Stephen J Forman
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California
| | - Smita Bhatia
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, Alabama
| | - Lee W Jones
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
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Keats MR, Cui Y, Grandy SA, Parker L. Cardiovascular disease and physical activity in adult cancer survivors: a nested, retrospective study from the Atlantic PATH cohort. J Cancer Surviv 2016; 11:264-273. [PMID: 27854007 DOI: 10.1007/s11764-016-0584-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 11/09/2016] [Indexed: 01/19/2023]
Abstract
PURPOSE The study aimed to examine the relationship between cardiovascular disease (CVD) and physical activity (PA) levels in cancer survivors (CS). METHODS Using a nested, retrospective follow-up design, this study presents the self-reported prevalence of CVD in an Atlantic Canadian population-based cohort of 1526 CS and 6034 age-sex matched, non-cancer controls ranging from 35 to 69 years of age. Univariate and multiple logistic regression models were used to explore the association between CVD and PA. RESULTS Overall, CS were 30% more likely to have ever experienced a CVD event than controls (OR = 1.3; 95% CI 1-1.7, p = .07). Survivors were also significantly more likely to report having hypertension (OR = 1.60; 95% CI 1.03-1.3, p = .02) and diabetes (OR = 1.27; 95% CI 1.03-1.16, p = .02). Compared to controls, CS were significantly less likely to engage in high levels of PA. For survivors, compared to those who were least physically active, the odds of having a CVD risk factor was 35% lower for those who were moderately active (OR = 0.65; 95% CI 0.48-0.88) and 45% lower in the most highly active group (OR = 0.55; 95% CI 0.4-0.73). For controls, the odds of having a CVD risk factor was 25% lower for those in the moderately active group (OR = 0.75; 95% CI 0.64-0.88) and 30% lower for those in the high active group (OR = 0.70; 95% CI 0.6-0.81). CONCLUSION Low active survivors appear to be at a high risk of CVD-related comorbidity. IMPLICATIONS FOR CANCER SURVIVORS PA is associated with lower CVD-related comorbidity in CS, suggesting that interventions directed at increasing PA should be implemented to improve long-term health outcomes.
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Affiliation(s)
- Melanie R Keats
- School of Health and Human Performance, Dalhousie University, 6230 South Street, Halifax, NS, B3H 4R2, Canada.
| | - Yunsong Cui
- Population Cancer Research Program, Dalhousie University, 1494 Carlton Street, Halifax, NS, B3H 3B7, Canada
| | - Scott A Grandy
- School of Health and Human Performance, Dalhousie University, 6230 South Street, Halifax, NS, B3H 4R2, Canada
| | - Louise Parker
- Population Cancer Research Program, Dalhousie University, 1494 Carlton Street, Halifax, NS, B3H 3B7, Canada
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Critically ill allogeneic hematopoietic stem cell transplantation patients in the intensive care unit: reappraisal of actual prognosis. Bone Marrow Transplant 2016; 51:1050-61. [PMID: 27042832 DOI: 10.1038/bmt.2016.72] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Revised: 02/14/2016] [Accepted: 02/17/2016] [Indexed: 12/16/2022]
Abstract
The outcome of allogeneic hematopoietic stem cell transplantation (allo-HSCT) patients has significantly improved over the past decade. Still, a significant number of patients require intensive care unit (ICU) management because of life-threatening complications. Literature from the 1990s reported extremely poor prognosis for critically ill allo-HSCT patients requiring ICU management. Recent data justify the use of ICU resources in hematologic patients. Yet, allo-HSCT remains an independent variable associated with mortality. However, outcomes in allo-HSCT patients have improved over time and many classic determinants of mortality have become irrelevant. The main actual prognostic factors are the need for mechanical ventilation, the presence of GvHD and the number of organ failures at ICU admission. Recently, the development of reduced-intensity conditioning regimens, early ICU admission and the increased use of noninvasive ventilation, combined with time effect and general advances in hematology, in allo-HSCT procedures and in ICU management have contributed to improve general outcome. A rational policy of ICU admission triage in these patients is very hard to define, as each decision for ICU admission is a case-by-case decision at patient bedside. The collaboration between hematologists and intensivists is crucial in this context.
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Blaes A, Konety S, Hurley P. Cardiovascular Complications of Hematopoietic Stem Cell Transplantation. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2016; 18:25. [PMID: 26909819 PMCID: PMC4766226 DOI: 10.1007/s11936-016-0447-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OPINION STATEMENT Survivors of hematopoietic stem cell transplant (HSCT) are at significant risk for cardiac disease and cardiac complications. While there may be cardiac complications during the acute period of HSCT, long-term survivors remain at risk for cardiovascular disease at a rate at least fourfold higher than the general population. Aggressive screening for cardiac risk factors such as diabetes, hypertension, and arrhythmias is warranted pretransplant. For those with risk factors, particularly a history of cardiovascular disease or atrial fibrillation, cardiology consultation is warranted in the pretransplantation period. Aggressive screening for cardiac risk factors such as diabetes, hypertension, and hyperlipidemia is warranted in HSCT survivors as well; early and aggressive treatment of left ventricular dysfunction is warranted. Collaboration between hematology/oncology and cardiology through a cardio-oncology clinic is an optimal way to help manage these patients.
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Affiliation(s)
- Anne Blaes
- Division of Hematology/Oncology/Transplantion, University of Minnesota, 420 Delaware Street, S.E., MMC 480, Minneapolis, MN, 55455, USA.
| | - Suma Konety
- Division of Cardiology, University of Minnesota, Minneapolis, MN, USA
| | - Peter Hurley
- Division of Hematology/Oncology/Transplantion, University of Minnesota, 420 Delaware Street, S.E., MMC 480, Minneapolis, MN, 55455, USA
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Clinical and Genetic Determinants of Cardiomyopathy Risk among Hematopoietic Cell Transplantation Survivors. Biol Blood Marrow Transplant 2016; 22:1094-1101. [PMID: 26968791 DOI: 10.1016/j.bbmt.2016.02.017] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 02/18/2016] [Indexed: 01/26/2023]
Abstract
Cardiomyopathy has been recognized as a complication after hematopoietic cell transplantation (HCT). Using a nested case-cohort design, we examined the relationships between demographic, therapeutic, and selected cardiovascular disease risk factors among ≥1-year HCT survivors who developed cardiomyopathy before (n = 43) or after (n = 89) 1 year from HCT as compared to a randomly selected subcohort of survivors without cardiomyopathy (n = 444). Genomic data were available for 79 cases and 267 noncases. Clinical and genetic covariates were examined for association with the risk of early or late cardiomyopathy. Clinical risk factors associated with both early- and late-onset cardiomyopathy included anthracycline exposure ≥250 mg/m(2) and pre-existing hypertension. Among late-onset cardiomyopathy cases, the development of diabetes and ischemic heart disease further increased risk. We replicated several previously reported genetic associations among early-onset cardiomyopathy cases, including rs1786814 in CELF4, rs2232228 in HAS3, and rs17863783 in UGT1A6. None of these markers were associated with risk of late-onset cardiomyopathy. A combination of demographic, treatment, and clinical covariates predicted early-onset cardiomyopathy with reasonable accuracy (area under the curve [AUC], .76; 95% confidence interval [CI], .68 to .83), but prediction of late cardiomyopathy was poor (AUC, .59; 95% CI .53 to .67). The addition of genetic polymorphisms with marginal associations (odds ratios ≥1.3) did not enhance prediction for either early- or late-onset cardiomyopathy. Conventional cardiovascular risk factors influence the risk of both early- and late-onset cardiomyopathy in HCT survivors. Although certain genetic markers may influence the risk of early-onset disease, further work is required to validate previously reported findings and to determine how genetic information should be incorporated into clinically useful risk prediction models.
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Armenian SH, Xu L, Ky B, Sun C, Farol LT, Pal SK, Douglas PS, Bhatia S, Chao C. Cardiovascular Disease Among Survivors of Adult-Onset Cancer: A Community-Based Retrospective Cohort Study. J Clin Oncol 2016; 34:1122-30. [PMID: 26834065 DOI: 10.1200/jco.2015.64.0409] [Citation(s) in RCA: 349] [Impact Index Per Article: 43.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
PURPOSE Cardiovascular diseases (CVDs), including ischemic heart disease, stroke, and heart failure, are well-established late effects of therapy in survivors of childhood and young adult (< 40 years at diagnosis) cancers; less is known regarding CVD in long-term survivors of adult-onset (≥ 40 years) cancer. METHODS A retrospective cohort study design was used to describe the magnitude of CVD risk in 36,232 ≥ 2-year survivors of adult-onset cancer compared with matched (age, sex, and residential ZIP code) noncancer controls (n = 73,545) within a large integrated managed care organization. Multivariable regression was used to examine the impact of cardiovascular risk factors (CVRFs; hypertension, diabetes, dyslipidemia) on long-term CVD risk in cancer survivors. RESULTS Survivors of multiple myeloma (incidence rate ratio [IRR], 1.70; P < .01), carcinoma of the lung/bronchus (IRR, 1.58; P < .01), non-Hodgkin lymphoma (IRR, 1.41; P < .01), and breast cancer (IRR, 1.13; P < .01) had significantly higher CVD risk when compared with noncancer controls. Conversely, prostate cancer survivors had a lower CVD risk (IRR, 0.89; P < .01) compared with controls. Cancer survivors with two or more CVRFs had the highest risk of CVD when compared with noncancer controls with less than two CVRFs (IRR, 1.83 to 2.59; P < .01). Eight-year overall survival was significantly worse among cancer survivors who developed CVD (60%) when compared with cancer survivors without CVD (81%; P < .01). CONCLUSION The magnitude of subsequent CVD risk varies according to cancer subtype and by the presence of CVRFs. Overall survival in survivors who develop CVD is poor, emphasizing the need for targeted prevention strategies for individuals at highest risk of developing CVD.
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Affiliation(s)
- Saro H Armenian
- Saro H. Armenian, Canlan Sun, and Sumanta Kumar Pal, City of Hope Comprehensive Cancer Center, Duarte; Lanfang Xu and Chun Chao, Kaiser Permanente Southern California, Pasadena; Leonardo T. Farol, City of Hope-Kaiser Permanente, Los Angeles, CA; Bonnie Ky, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Pamela S. Douglas, Duke Clinical Research Institute, Duke University, Durham, NC; and Smita Bhatia, University of Alabama at Birmingham, Birmingham, AL.
| | - Lanfang Xu
- Saro H. Armenian, Canlan Sun, and Sumanta Kumar Pal, City of Hope Comprehensive Cancer Center, Duarte; Lanfang Xu and Chun Chao, Kaiser Permanente Southern California, Pasadena; Leonardo T. Farol, City of Hope-Kaiser Permanente, Los Angeles, CA; Bonnie Ky, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Pamela S. Douglas, Duke Clinical Research Institute, Duke University, Durham, NC; and Smita Bhatia, University of Alabama at Birmingham, Birmingham, AL
| | - Bonnie Ky
- Saro H. Armenian, Canlan Sun, and Sumanta Kumar Pal, City of Hope Comprehensive Cancer Center, Duarte; Lanfang Xu and Chun Chao, Kaiser Permanente Southern California, Pasadena; Leonardo T. Farol, City of Hope-Kaiser Permanente, Los Angeles, CA; Bonnie Ky, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Pamela S. Douglas, Duke Clinical Research Institute, Duke University, Durham, NC; and Smita Bhatia, University of Alabama at Birmingham, Birmingham, AL
| | - Canlan Sun
- Saro H. Armenian, Canlan Sun, and Sumanta Kumar Pal, City of Hope Comprehensive Cancer Center, Duarte; Lanfang Xu and Chun Chao, Kaiser Permanente Southern California, Pasadena; Leonardo T. Farol, City of Hope-Kaiser Permanente, Los Angeles, CA; Bonnie Ky, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Pamela S. Douglas, Duke Clinical Research Institute, Duke University, Durham, NC; and Smita Bhatia, University of Alabama at Birmingham, Birmingham, AL
| | - Leonardo T Farol
- Saro H. Armenian, Canlan Sun, and Sumanta Kumar Pal, City of Hope Comprehensive Cancer Center, Duarte; Lanfang Xu and Chun Chao, Kaiser Permanente Southern California, Pasadena; Leonardo T. Farol, City of Hope-Kaiser Permanente, Los Angeles, CA; Bonnie Ky, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Pamela S. Douglas, Duke Clinical Research Institute, Duke University, Durham, NC; and Smita Bhatia, University of Alabama at Birmingham, Birmingham, AL
| | - Sumanta Kumar Pal
- Saro H. Armenian, Canlan Sun, and Sumanta Kumar Pal, City of Hope Comprehensive Cancer Center, Duarte; Lanfang Xu and Chun Chao, Kaiser Permanente Southern California, Pasadena; Leonardo T. Farol, City of Hope-Kaiser Permanente, Los Angeles, CA; Bonnie Ky, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Pamela S. Douglas, Duke Clinical Research Institute, Duke University, Durham, NC; and Smita Bhatia, University of Alabama at Birmingham, Birmingham, AL
| | - Pamela S Douglas
- Saro H. Armenian, Canlan Sun, and Sumanta Kumar Pal, City of Hope Comprehensive Cancer Center, Duarte; Lanfang Xu and Chun Chao, Kaiser Permanente Southern California, Pasadena; Leonardo T. Farol, City of Hope-Kaiser Permanente, Los Angeles, CA; Bonnie Ky, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Pamela S. Douglas, Duke Clinical Research Institute, Duke University, Durham, NC; and Smita Bhatia, University of Alabama at Birmingham, Birmingham, AL
| | - Smita Bhatia
- Saro H. Armenian, Canlan Sun, and Sumanta Kumar Pal, City of Hope Comprehensive Cancer Center, Duarte; Lanfang Xu and Chun Chao, Kaiser Permanente Southern California, Pasadena; Leonardo T. Farol, City of Hope-Kaiser Permanente, Los Angeles, CA; Bonnie Ky, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Pamela S. Douglas, Duke Clinical Research Institute, Duke University, Durham, NC; and Smita Bhatia, University of Alabama at Birmingham, Birmingham, AL
| | - Chun Chao
- Saro H. Armenian, Canlan Sun, and Sumanta Kumar Pal, City of Hope Comprehensive Cancer Center, Duarte; Lanfang Xu and Chun Chao, Kaiser Permanente Southern California, Pasadena; Leonardo T. Farol, City of Hope-Kaiser Permanente, Los Angeles, CA; Bonnie Ky, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Pamela S. Douglas, Duke Clinical Research Institute, Duke University, Durham, NC; and Smita Bhatia, University of Alabama at Birmingham, Birmingham, AL
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Scott JM, Armenian S, Giralt S, Moslehi J, Wang T, Jones LW. Cardiovascular disease following hematopoietic stem cell transplantation: Pathogenesis, detection, and the cardioprotective role of aerobic training. Crit Rev Oncol Hematol 2016; 98:222-34. [PMID: 26643524 PMCID: PMC5003053 DOI: 10.1016/j.critrevonc.2015.11.007] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Revised: 11/10/2015] [Accepted: 11/11/2015] [Indexed: 01/02/2023] Open
Abstract
Advances in hematopoietic cell transplantation (HCT) techniques and supportive care strategies have led to dramatic improvements in relapse mortality in patients with high-risk hematological malignancies. These improvements, however, conversely increase the risk of late-occurring non-cancer competing causes, mostly cardiovascular disease (CVD). HCT recipients have a significantly increased risk of CVD-specific mortality, including elevated incidence of coronary artery disease (CAD), cerebrovascular disease, and heart failure (HF) compared to age-matched counterparts. Accordingly, there is an urgent need to identify techniques for the detection of early CVD in HCT patients to inform early prevention strategies. Aerobic training (AT) is established as the cornerstone of primary and secondary disease prevention in multiple clinical settings, and may confer similar benefits in HCT patients at high-risk of CVD. The potential benefits of AT either before, immediately after, or in the months/years following HCT have received limited attention. Here, we discuss the risk and extent of CVD in adult HCT patients, highlight novel tools for early detection of CVD, and review existing evidence in oncology and non-oncology populations supporting the efficacy of AT to attenuate HCT-induced CVD. This knowledge can be utilized to optimize treatment, while minimizing CVD risk in individuals with hematological malignancies undergoing HCT.
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Affiliation(s)
- Jessica M Scott
- Universities Space Research Association NASA Johnson Space Center, Houston, TX, USA
| | - Saro Armenian
- City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Sergio Giralt
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | | | - Lee W Jones
- Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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58
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Jones LW, Devlin SM, Maloy MA, Wood WA, Tuohy S, Espiritu N, Aquino J, Kendig T, Michalski MG, Gyurkocza B, Schaffer WL, Ali B, Giralt S, Jakubowski AA. Prognostic Importance of Pretransplant Functional Capacity After Allogeneic Hematopoietic Cell Transplantation. Oncologist 2015; 20:1290-7. [PMID: 26446235 DOI: 10.1634/theoncologist.2015-0200] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Accepted: 08/18/2015] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The purpose of this study was to investigate the prognostic importance of functional capacity in patients undergoing allogeneic hematopoietic cell transplantation (HCT) for hematological malignancies. PATIENTS AND METHODS Using a retrospective design, 407 patients completed a 6-minute walk distance (6 MWD) test to assess functional capacity before HCT; 193 (47%) completed a 6 MWD test after hospital discharge. Cox proportional hazards regression was used to estimate the risk of nonrelapse mortality (NRM) and overall survival (OS) according to the 6 MWD category (<400 m vs. ≥ 400 m) and the change in 6 MWD (before HCT to discharge) with or without adjustment for Karnofsky performance status (KPS), age, and other prognostic markers. RESULTS Compared with <400 m, the unadjusted hazard ratio for NRM was 0.65 (95% confidence interval, 0.44-0.96) for a 6 MWD ≥ 400 m. A 6 MWD of ≥ 400 m provided incremental information on the prediction of NRM with adjustment for age (p = .032) but not KPS alone (p = .062) or adjustment for other prognostic markers (p = .099). A significant association was found between the 6 MWD and OS (p = .027). A 6 MWD of ≥ 400 m provided incremental information on the prediction of OS with adjustment for age (p = .032) but not for other prognostic markers (p > .05 for all). Patients presenting with a pre-HCT 6 MWD of <400 m and experiencing a decline in 6 MWD had the highest risk of NRM. CONCLUSION The 6 MWD is a significant univariate predictor of clinical outcomes but did not provide prognostic information beyond that of traditional prognostic markers in HCT. IMPLICATIONS FOR PRACTICE The pretransplant 6-minute walk test is a significant univariate predictor of clinical outcomes in hematological patients beyond age but not beyond that of performance status. On this basis, 6-minute walk distance testing should not be considered part of the standard battery of assessments for risk stratification before hematopoietic cell transplantation.
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Affiliation(s)
- Lee W Jones
- Memorial Sloan Kettering Cancer Center, New York, New York, USA Weill Cornell Medical College, Cornell University, New York, New York, USA
| | - Sean M Devlin
- Memorial Sloan Kettering Cancer Center, New York, New York, USA Weill Cornell Medical College, Cornell University, New York, New York, USA
| | - Molly A Maloy
- Memorial Sloan Kettering Cancer Center, New York, New York, USA Weill Cornell Medical College, Cornell University, New York, New York, USA
| | - William A Wood
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Sharlynn Tuohy
- Memorial Sloan Kettering Cancer Center, New York, New York, USA Weill Cornell Medical College, Cornell University, New York, New York, USA
| | - Noel Espiritu
- Memorial Sloan Kettering Cancer Center, New York, New York, USA Weill Cornell Medical College, Cornell University, New York, New York, USA
| | - Jennifer Aquino
- Memorial Sloan Kettering Cancer Center, New York, New York, USA Weill Cornell Medical College, Cornell University, New York, New York, USA
| | - Tiffany Kendig
- Memorial Sloan Kettering Cancer Center, New York, New York, USA Weill Cornell Medical College, Cornell University, New York, New York, USA
| | - Meghan G Michalski
- Memorial Sloan Kettering Cancer Center, New York, New York, USA Weill Cornell Medical College, Cornell University, New York, New York, USA
| | - Boglarka Gyurkocza
- Memorial Sloan Kettering Cancer Center, New York, New York, USA Weill Cornell Medical College, Cornell University, New York, New York, USA
| | - Wendy L Schaffer
- Memorial Sloan Kettering Cancer Center, New York, New York, USA Weill Cornell Medical College, Cornell University, New York, New York, USA
| | - Benzar Ali
- Memorial Sloan Kettering Cancer Center, New York, New York, USA Weill Cornell Medical College, Cornell University, New York, New York, USA
| | - Sergio Giralt
- Memorial Sloan Kettering Cancer Center, New York, New York, USA Weill Cornell Medical College, Cornell University, New York, New York, USA
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59
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Tonorezos ES, Stillwell EE, Calloway JJ, Glew T, Wessler JD, Rebolledo BJ, Pham A, Steingart RM, Lazarus H, Gale RP, Jakubowski AA, Schaffer WL. Arrhythmias in the setting of hematopoietic cell transplants. Bone Marrow Transplant 2015; 50:1212-6. [PMID: 26030046 PMCID: PMC4558298 DOI: 10.1038/bmt.2015.127] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Revised: 03/15/2015] [Accepted: 04/09/2015] [Indexed: 11/15/2022]
Abstract
Prior studies report 9–27% of persons receiving a hematopoietic cell transplant develop arrhythmias, but the effect on outcomes is largely unknown. We reviewed data from 1177 consecutive patients {greater than or equal to}40 years old receiving a hematopoietic cell transplant at one center during 1999–2009. Transplant indication was predominately leukemia, lymphoma and multiple myeloma. Overall, 104 patients were found to have clinically significant arrhythmia: 43 prior to and 61 following transplant. Post-transplant arrhythmias were most frequently atrial fibrillation(N=30), atrial flutter(N=7) and supraventricular tachycardia(N=11). Subjects with an arrhythmia post-transplant were more likely to have longer median hospital stays (32 days vs 23, P=<.001,) a greater probability of an ICU admission (52% vs 7%; P<.001), more inhospital deaths (28% vs 3%, P<0.001), and more deaths within one year of transplant (41% vs 15%; P<0.001) than patients without arrhythmia at any time. In a multivariate model including age at transplant, diagnosis, history of pre-transplant arrhythmia, and transplant-related variables, post-transplant arrhythmia was associated with a greater risk of death within a year of transplant (OR 3.5, 95% CI: 2.1, 5.9; P < 0.001). Our data suggest arrhythmias after transplants are associated with significant morbidity and mortality. A prospective study of arrhythmia in the transplant setting is warranted.
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Affiliation(s)
- E S Tonorezos
- Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.,Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - E E Stillwell
- Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - J J Calloway
- Department of Medicine, Hospital for Special Surgery, New York, NY, USA
| | - T Glew
- Department of Medicine, Beth Israel Medical Center, New York, NY, USA
| | - J D Wessler
- Department of Medicine, New York Presbyterian-Columbia, New York, NY, USA
| | - B J Rebolledo
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - A Pham
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - R M Steingart
- Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.,Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - H Lazarus
- Department of Medicine, UH Case Medical Center, Cleveland, OH, USA
| | - R P Gale
- Haematology Research Centre, Division of Experimental Medicine, Department of Medicine, Imperial College London, London, UK
| | - A A Jakubowski
- Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.,Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - W L Schaffer
- Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.,Department of Medicine, Weill Cornell Medical College, New York, NY, USA
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60
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Differences in health behaviour between recipients of allogeneic haematopoietic SCT and the general population: a matched control study. Bone Marrow Transplant 2014; 49:1223-30. [PMID: 25046214 DOI: 10.1038/bmt.2014.142] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Revised: 05/12/2014] [Accepted: 05/23/2014] [Indexed: 12/30/2022]
Abstract
Little is known of health-relevant behaviour among long-term survivors of haematological disorders treated with haematopoietic SCT. This comparative cross-sectional multicentre study aimed (1) to explore the prevalence of selected behaviours in this group and (2) to compare them with those of the general population. Self-reported data of 376 survivors (mean age: 50.4 (s.d. = 12.8); median 7 years postallogeneic SCT (interquartile range (IQR) = 8.9; range 1-33) were compared with controls derived from the Swiss Health Survey 2007 by propensity score matching. Survivors were more physically inactive (26.8% vs 12.5%; P ⩽ 0.001) and consumed fewer portions of vegetables (⩾ 3 pieces: 10% vs 21.6%; P < 0.001), fruits (⩾ 3 pieces: 6.5% vs 10.6%; P < 0.001) and fish (31.2% vs 60.9% weekly fish dish; P < 0.001). More survivors consumed dairy products daily (92.5% vs 62.9%; P < 0.001), used sun protection regularly (94.5% vs 85.3%, P < 0.001) and had received influenza vaccinations in the past year (58.4% vs 21.5%; P < 0.001); fewer survivors smoked (13.4% vs 35.4%; P < 0.001). Survivors' weekly alcohol consumption was lower (median 1.5 servings (IQR 4) vs median 4.5 (IQR 10.3); P < 0.001). Of those taking immunosuppressants, 65.7% were non-adherent. Similar to the general population, survivors experience problems executing several health-enhancing behaviours, warranting corrective interventions.
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