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Cardiovascular Complications

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Abstract

The assessment of cardiovascular risk and attention to the cardiovascular system of patients undergoing hematopoietic cell transplant (HCT), as well as an awareness of the treatment’s potential long-term cardiac effects are critical in the overall care of these complex and vulnerable patients. The issues facing patients and their treating clinicians are primarily centered in three arenas: (1) cardiovascular comorbidities and the overall cardiovascular reserve, (2) chemotherapy and radiation–associated cardiovascular toxicities, and (3) long-term effects of HCT.

As it stands, there are well over 160,000 HCT survivors living in the United States today, and that number is expected to exceed 500,000 by 2030 (Altekruse SF, Kosary CL KM. SEER cancer statistics review, 1975–2007. 2010. http://seer.cancer.gov/csr/1975_2007, Accessed March 7 2019; Majhail NS, Tao L, Bredeson C, et al. Prevalence of hematopoietic cell transplant survivors in the United States. Biol Blood Marrow Transpl. 2013;19(10):1498–1501). HCT survivors carry increased risk of future cardiovascular disease compared to the general population, with pre-transplant comorbidities playing a major role (Fig. 34.1) (NCCN Clinical Practice Guidelines in Oncology. Survivorship. Vol 2. 2017). Heart failure risk is close to 5% at 5 years and almost 10% at 15 years (Armenian SH, Lacchetti C, Barac A, et al. Prevention and Monitoring of Cardiac Dysfunction in Survivors of Adult Cancers: American Society of Clinical Oncology Clinical Practice Guideline. J Clin Onc 2017; 35:893–911). Arrhythmias make up the largest risk in this population, being notable in about a quarter of the population (Tonorezos ES, Stillwell EE, Calloway JJ, et al. Arrhythmias in the Setting of Hematopoietic Cell Transplants. Bone Marrow Transpl. 2016;50(9):1212–1216). Cardiotoxic side effects from various chemotherapeutic agents and chest wall radiation pose specific cardiovascular risks that are outlined in this chapter. With this information in mind, early recognition and treatment of cardiotoxicities, as well as the potential identification of at-risk patients, allows treating providers to optimize care of patients undergoing HCT, ensuring the best treatment of the underlying hematologic malignancy while mitigating cardiovascular risk. Lastly, monitoring of patients for long-term cardiovascular effects of HCT may prevent the success of cancer therapy from being overshadowed by cardiovascular morbidity and mortality.

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Authors and Affiliations

  1. Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR, USA

    Michael E. Layoun & Maros Ferencik

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  1. Michael E. Layoun
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  1. Center for Hematologic Malignancies Adult Blood and Marrow Transplant & Cell Therapy Program, Knight Cancer Institute Oregon Health & Science University, Portland, OR, USA

    Richard T. Maziarz

  2. Center for Hematologic Malignancies Adult Blood and Marrow Transplant & Cell Therapy Program, Knight Cancer Institute Oregon Health & Science University, Portland, OR, USA

    Susan Schubach Slater

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Layoun, M.E., Ferencik, M. (2021). Cardiovascular Complications. In: Maziarz, R.T., Slater, S.S. (eds) Blood and Marrow Transplant Handbook. Springer, Cham. https://doi.org/10.1007/978-3-030-53626-8_34

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