Chronic Graft Versus Host Disease (GVHD) Does Not Impact Cardiovascular Risk Factors in Survivors of Allogeneic Hematopoietic Stem Cell Transplantation (SCT) up to the Second Decade Post-Transplant,

Abstract 4099

Long term survivors of allogeneic SCT have increased risk factors for cardiovascular disease. The reason for this is unclear but chronic GVHD (cGVHD) has been implicated as a potential cause. We prospectively evaluated the impact of cGVHD on cardiovascular risk profiles in 109 allogeneic stem cell transplantation survivors. Transplants were performed at a single center between 1993 and 2006. Sixty-four survivors were informative at 5 years, 45 at > 10 years and 35 at both 5 and 10 years post-transplant. Median ages at transplant, 5 and 10 year follow-up were 34, 40 and 46 years, respectively. There were 62 male and 47 female survivors. Diagnoses at transplant included CML (56), acute leukemia (29), MDS (13), and others (9). Ninety-nine patients received 12–13Gy TBI-based conditioning followed by a 4-log T cell depleted SCT (15 marrow and 84 peripheral blood). Ten patients received non-myeloablative conditioning followed by unmanipulated peripheral blood stem cells. There were clinically relevant increases in prevalence of hypertension (p=<0.001), diabetes (p=0.018), C-reactive protein (CRP) (p<0.001) and Body Mass Index (BMI) (p=0.044) at follow-up compared to baseline (see Table). Dyslipidemias (defined by ATP III criteria) were found in 44% and 52% of 5 and 10 year post-transplant survivors, respectively. At follow-up, 6 of 19 pre-transplant smokers continued to smoke. There was no change in prevalence of any cardiovascular risk factor between the 5 and 10 year time-points. Despite this significant increase in risk factors, clinical cardiovascular events and mortality were uncommon. At the time of analysis, of 12 deaths, only one was due to a cardiovascular cause (cerebrovascular accident). In addition, 2 survivors required percutaneous coronary intervention and one had recurrent pulmonary emboli. Serial electrocardiograms revealed 6 survivors with new ischemic changes and 28 with new rhythm or conduction abnormalities. There was no significant change in left ventricular ejection fraction at follow-up in any survivor compared to their pre-transplant baseline. Of the survivors, 35 had no cGVHD, 18 had cGVHD lasting <3 years and 56 had prolonged cGVHD requiring >3 years of systemic immunosuppression. cGVHD did not exert significant influence on any cardiovascular risk factors at any time-point. This study demonstrates that post-transplant survivors have important and prolonged elevations in cardiovascular risk factors. Although elevations in CRP suggest a persistent chronic inflammatory state, cGVHD was not responsible for the heightened cardiovascular risk profile of these individuals.