异基因造血干细胞移植后心力衰竭。
Heart failure after allogeneic hematopoietic stem cell transplantation.
机构信息
Peking University People's Hospital & Institute of Hematology, Beijing Key laboratory of Hematopoitic Stem Cell Transplantation, No 11, South Street of Xizhimen Beijing 100044, PR China.
出版信息
Int J Cardiol. 2013 Sep 10;167(6):2502-6. doi: 10.1016/j.ijcard.2012.06.021. Epub 2012 Jun 22.
BACKGROUND
Heart failure (HF) occurring after allogeneic hematopoietic stem cell transplantation (allo-HSCT) is rare but severe. We examine the role of pre-HSCT therapeutic exposures, conditioning regimens, pre-HSCT comorbidities, severe transplant-related complications, and post-HSCT cardiovascular risk factors in the development of heart failure after allo-HSCT.
METHODS
A nested case-control study was designed. Cases with HF and controls matched for age, year of allo-HSCT, and length of follow-up were identified from a cohort of 2455 patients who underwent allo-HSCT between 2000 and 2011 for hematologic malignancies.
RESULTS
Forty-two patients suffered from HF; mean age at presentation was 35 years (± 14 years) and mean time to presentation was 5 months (± 9 months) post-HSCT. The number of pre-HSCT cycles of chemotherapy was significantly greater (7 vs. 5 courses, P=0.023). Cases were significantly more likely to have severe acute GVHD (≥ grade III), hemorrhagic cystitis (≥ grade 2), and multiple severe transplant-related complications compared with controls (42.9% vs. 20.4%, P=0.008). Multivariate analysis revealed that pre-HSCT cycles of chemotherapy of ≥ 5 courses (OR=3.5, P=0.003) and two or more severe transplant-related complications (OR=3.6, P=0.003) were independently associated with HF.
CONCLUSIONS
These results identify the individuals who are at higher risk of developing HF after allo-HSCT. We should pay more attention to these patients and more active management would be reasonable.
背景
异基因造血干细胞移植（allo-HSCT）后发生心力衰竭（HF）较为罕见，但病情严重。我们研究了 allo-HSCT 前的治疗暴露、预处理方案、 allo-HSCT 前合并症、严重的移植相关并发症以及 allo-HSCT 后心血管危险因素在 HF 发展中的作用。
方法
设计了一项巢式病例对照研究。从 2000 年至 2011 年间接受 allo-HSCT 治疗血液系统恶性肿瘤的 2455 例患者队列中，确定了 HF 患者（病例）和年龄、 allo-HSCT 年份和随访时间匹配的对照（对照）。
结果
42 例患者发生 HF；中位发病年龄为 35 岁（±14 岁），中位发病时间为 allo-HSCT 后 5 个月（±9 个月）。 allo-HSCT 前的化疗周期数明显较多（7 个周期 vs. 5 个周期，P=0.023）。与对照组相比，病例更易发生严重急性移植物抗宿主病（≥ III 级）、出血性膀胱炎（≥ II 级）和多种严重移植相关并发症（42.9% vs. 20.4%，P=0.008）。多变量分析显示， allo-HSCT 前化疗周期数≥5 个（OR=3.5，P=0.003）和≥2 种严重移植相关并发症（OR=3.6，P=0.003）与 HF 独立相关。
结论
这些结果确定了 allo-HSCT 后发生 HF 风险较高的个体。我们应更加关注这些患者，采取更积极的治疗策略是合理的。
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