Cardiovascular Disease After Hematopoietic Stem Cell Transplantation in Adults

Figures

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  Figure 1. Indications, Procedures, and Goals of Autologous and Allogeneic HCT This figure details the indications for hematopoietic stem cell transplantation (HCT), as well as the pre-HCT procedures and condition regimens. Briefly, 1) stem cells are harvested, 2) patients receive conditioning tailored to their comorbidities and underlying disease, 3) stem cells are reinfused with autologous and allogeneic HCT having different primary treatment effects. The desired treatment effects and goals of treatment are also detailed. G-CSF = granulocyte-colony stimulating factor; NHL = non-Hodgkin lymphoma; PBMC = peripheral blood mononuclear cell.

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  Central Illustration. Short- and Long-Term Cardiotoxicity and Proposed Recommendations for the Assessment, Treatment, and Monitoring of Cardiovascular Complications The short- and long-term cardiovascular (CV) complications are briefly noted here, with Table 2 providing additional detail including incidence rates. Various potential strategies are recommended for baseline assessment, risk stratification, and optimization, as well as monitoring and surveillance, although this should be tailored to the individual patient. Additional research is needed to define the optimal strategies for surveillance, risk assessment, and risk mitigation. ∗High risk = pre-existing CV disease, multiple poorly controlled CV risk factors, graft-versus-host disease, high doses of chest-directed radiotherapy, doxorubicin ≥250 mg/m2, the use of alkylating agents, or total body irradiation during transplant conditioning. BMI = body mass index; CARE-BMT = Cardiovascular Registry in Bone Marrow Transplantation; CMR = cardiac magnetic resonance; ECG = electrocardiogram; HbA1c = glycated hemoglobin; ECG = electrocardiogram; HCT = hematopoietic stem cell transplantation; HCT-CI = hematopoietic stem cell transplant comorbidity index;…