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Published in: Current Oncology Reports 3/2019

01-03-2019 | Stem Cell Transplantion | Cardio-oncology (EH Yang, Section Editor)

Cardiac Complications in the Adult Bone Marrow Transplant Patient

Authors: Mirela Tuzovic, Monica Mead, Patricia A. Young, Gary Schiller, Eric H. Yang

Published in: Current Oncology Reports | Issue 3/2019

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Abstract

Purpose of Review

Due to advancements in oncologic treatment strategies and techniques, the number of survivors who have undergone hematopoetic stem cell transplant (HCT) continues to increase in the United States; this number is projected to reach 502,000 by the year 2030. There is significant interest within the field of cardio-oncology to identify cardiotoxicity and cardiovascular disease in the HCT population. Epidemiologic studies analyzing both short- and long-term cardiovascular effects, risk stratification modeling, cardioprotective strategies, and expert consensus documents for cardiotoxicity surveillance recommendations are reviewed.

Recent Findings

Patients who have undergone HCT are at increased risk of cardiovascular events and mortality compared to matched controls. The type of cardiotoxicity and the incidence rates vary based on specific therapeutic regimens and pre-existing cardiovascular risk factors. Life-threatening cardiotoxicity can present during HCT as acute heart failure, arrhythmias, pericardial tamponade, or cardiac arrest; or it can present late after treatment as cardiomyopathy, ischemic heart disease, vascular disease, stroke, or comorbid conditions, such as hypertension and diabetes mellitus that are associated with cardiac events.

Summary

HCT is associated with excess cardiovascular risk partially due to exposure to cardiotoxic chemotherapy and radiation, as well as indirect and direct detrimental effects on cardiovascular reserve. This review discusses the epidemiology and the known cardiotoxic effects of historical chemoradiation agents in addition to newer targeted therapies. Recent expert consensus statements from cardiology and hematology/oncology societies are reviewed in regard to risk stratification of the cancer patient based on the type of treatments. Finally, gaps in knowledge are identified with proposed avenues of research that will allow for more accurate risk assessment, prediction, and potential treatment of the HCT patient in attenuating the risk of developing both short- and long-term cardiovascular comorbidities.
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Metadata
Title
Cardiac Complications in the Adult Bone Marrow Transplant Patient
Authors
Mirela Tuzovic
Monica Mead
Patricia A. Young
Gary Schiller
Eric H. Yang
Publication date
01-03-2019
Publisher
Springer US
Published in
Current Oncology Reports / Issue 3/2019
Print ISSN: 1523-3790
Electronic ISSN: 1534-6269
DOI
https://doi.org/10.1007/s11912-019-0774-6

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