Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York, USA.
Biol Blood Marrow Transplant. 2011 Aug;17(8):1182-6. doi: 10.1016/j.bbmt.2010.12.698. Epub 2010 Dec 21.
Hematopoietic stem cell transplantation (HSCT) represents an extended period of physiologic stress. It is unknown whether patients with pre-existing coronary artery disease (CAD) may be poor transplant candidates. There are no data analyzing the risk of transplantation in this population. Sixty-nine patients with CAD who underwent 72 transplantations, autologous and allogeneic, were identified retrospectively. Fifty-five percent of these patients had prior percutaneous coronary intervention, 42% had verifiable history of myocardial infarction, and 23% had prior coronary artery bypass grafting. Outcomes were compared to 1109 patients without established CAD who underwent 1183 transplants during the same time period. Cancer diagnoses in the 2 groups were similar, predominantly lymphoma, multiple myeloma, and leukemia. There was no significant difference between the CAD group and the control group with respect to type of transplant (autologous 68% versus 64%, P = .612, myeloablative 86% versus 85%, P = .867). Treatment-related mortality was no different in the CAD group versus the control group (5.6% versus 4.9%, P = .777), nor were there differences in mortality at 1 year (15.3% versus 16.6%, P = .871), urgent intensive care unit admission (11.1% versus 9.9%, P = .686), or length of stay (25.5 days versus 28.4 days, P = .195). These findings suggest many patients with underlying coronary artery disease may be safely managed through hematopoietic stem cell transplantation.
造血干细胞移植（HSCT）代表了一段延长的生理应激期。目前尚不清楚是否患有预先存在的冠状动脉疾病（CAD）的患者可能不适合进行移植。目前没有针对该人群进行移植风险分析的数据。回顾性地确定了 69 例接受 72 例 HSCT（自体和同种异体）的 CAD 患者。这些患者中有 55%曾接受过经皮冠状动脉介入治疗，42%有可核实的心肌梗死病史，23%曾接受过冠状动脉旁路移植术。将这些结果与同一时期接受 1183 例移植且未确诊 CAD 的 1109 例患者进行了比较。两组患者的癌症诊断相似，主要为淋巴瘤、多发性骨髓瘤和白血病。CAD 组和对照组在移植类型方面无显著差异（自体 68%对 64%，P =.612，清髓性 86%对 85%，P =.867）。CAD 组与对照组的治疗相关死亡率无差异（5.6%对 4.9%，P =.777），1 年死亡率也无差异（15.3%对 16.6%，P =.871），紧急入住重症监护病房的比例（11.1%对 9.9%，P =.686）或住院时间（25.5 天对 28.4 天，P =.195）。这些发现表明，许多患有潜在冠状动脉疾病的患者可以通过造血干细胞移植安全地进行治疗。
