Fong Chong Mui, Jiun Lim Yan, Yen Ng Hong
Department of Pharmacy, Singapore General Hospital, Singapore.
Blood Cell Ther. 2021 Aug 25;4(3):65-74. doi: 10.31547/bct-2020-020.
Long-term survivors of allogeneic hematopoietic stem cell transplantation (alloHSCT) are at a substantial risk of developing medical late effects. We aimed to determine the incidence of metabolic syndrome (MS), cardiovascular (CV) events, bone density loss, and fractures in a cohort of patients who underwent alloHSCT for hematologic disorders. The potential risk factors for MS, CV events, bone density loss, and fractures, as well as the sufficiency of existing monitoring measures in our institution, were also evaluated.
A single-center, retrospective study was conducted. We included patients who underwent alloHSCT at the Singapore General Hospital between January 2011 and December 2016, were at least 21 years old, and had a minimum follow-up period of 6 months. Patients with MS-related data comprised the CV study population, whereas patients with bone loss-related data comprised the skeletal study population. Associations between risk factors and the development of MS or bone loss were assessed using a univariate analysis followed by multivariate logistic regression. All analyses were performed using SPSS version 23.
A total of 91 patients were included in the CV study population, of which 13 (14.3%) had preexisting MS, 17 (18.7%) developed MS, and 5 (5.5%) developed CV events after alloHSCT. Thirty-one patients were included in the skeletal study population, of which 2 (6.5%) had preexisting bone loss, 23 (71.0%) developed osteopenia or osteoporosis, and 2 (6.5%) had a fracture. After adjusting for preexisting MS, pretransplant abdominal obesity (p=0.002), elevated triglyceride (p<0.001), and fasting hyperglycemia (p<0.001) significantly predicted MS on multivariate analyses. Only female sex predicted the risk of bone loss after alloHSCT on multivariate analyses after adjusting for preexisting osteopenia (p=0.02). Of the 174 patients who underwent alloHSCT during the study period, 83 (47.7%) and 143 (82.2%) patients had no MS-related data and bone loss-related data, respectively.
Long-term alloHSCT survivors are at an increased risk of MS, CV complications, and bone loss. This underscores the importance of close monitoring and timely interventions to reduce long-term morbidity and mortality.
异基因造血干细胞移植（alloHSCT）的长期存活者面临发生医学晚期效应的重大风险。我们旨在确定因血液系统疾病接受alloHSCT的一组患者中代谢综合征（MS）、心血管（CV）事件、骨密度降低和骨折的发生率。我们还评估了MS、CV事件、骨密度降低和骨折的潜在风险因素，以及我们机构现有监测措施的充分性。
进行了一项单中心回顾性研究。我们纳入了2011年1月至2016年12月期间在新加坡总医院接受alloHSCT、年龄至少21岁且随访期至少6个月的患者。有MS相关数据的患者组成心血管研究人群，有骨质流失相关数据的患者组成骨骼研究人群。使用单因素分析，随后进行多因素逻辑回归，评估风险因素与MS或骨质流失发生之间的关联。所有分析均使用SPSS 23版进行。
心血管研究人群共纳入91例患者，其中13例（14.3%）既往有MS，17例（18.7%）在alloHSCT后发生MS，5例（5.5%）在alloHSCT后发生CV事件。骨骼研究人群纳入31例患者，其中2例（6.5%）既往有骨质流失，23例（71.0%）发生骨质减少或骨质疏松，2例（6.5%）发生骨折。在多因素分析中，校正既往MS后，移植前腹部肥胖（p=0.002）、甘油三酯升高（p<0.001）和空腹血糖升高（p<0.001）显著预测MS。在多因素分析中，校正既往骨质减少后，仅女性性别预测alloHSCT后骨质流失风险（p=0.02）。在研究期间接受alloHSCT的174例患者中，分别有83例（47.7%）和143例（82.2%）患者没有MS相关数据和骨质流失相关数据。
alloHSCT长期存活者发生MS、CV并发症和骨质流失的风险增加。这凸显了密切监测和及时干预以降低长期发病率和死亡率的重要性。
