Key result
Hypoalbuminemia, anemia, low platelets, and depression predicted all-cause mortality, while a second HSCT was associated with non-fatal cardiovascular events (P=0.006).
Why the study?
Evidence regarding prognosis, CV events, and their predictors in cancer patients undergoing HSCT is limited despite improved clinical outcomes.
What are the predictors of all-cause mortality and cardiovascular events in cancer patients undergoing hematopoietic stem cell transplantation?
Cohort (n=490)
No
What are the predictors of all-cause mortality and cardiovascular events in cancer patients undergoing hematopoietic stem cell transplantation?
Answers are grounded in this paper and cite their sources.
In cancer patients undergoing hematopoietic stem cell transplantation, receiving a second transplant is a significant risk factor for future cardiovascular events, highlighting the need for cardio-oncology monitoring.
Backgrounds: Recent advances in chemotherapy and supportive therapy have resulted in improved clinical outcomes in cancer patients undergoing hematopoietic stem-cell transplantation (HSCT). However, there is limited evidence regarding prognosis, cardiovascular (CV) events and their predictors in patients undergoing HSCT. Therefore, we investigated the predictors for all-cause death and CV events in cancer patients undergoing HSCT. Methods: We enrolled 490 patients with hematological malignancies (n=399) and breast cancer (n= 91) in a prospective observational cohort study (Kurume-CREO study) in Kurume University from October 2016 to February 2021. Patients were followed up every 6 months after enrollment until August 2021. Outcomes were all-cause death, CV death and non-fatal CV events, the last defined as ≧ Grade 2 cardiac or vascular events based on CTCAE (Common Terminology Criteria for Adverse Events) v4.0-JCOG version. Results: The mean age ± standard deviation of all study subjects was 63.7 ± 13.4 years old. Among them, 107 all-cause deaths (21.8%), 84 CV events (17.1%, 3 CV deaths) were observed during the follow-up period (median:713.5 days). In this study, 60 patients (all were patients with hematological malignancies) received HSCT. The 3-year survival rate was 63.6% (Figure 1A) and the 3-year CV event-free rate was 70.7% (Figure 1B) in 60 patients with HSCT. Age- and sex-adjusted Cox proportional hazards analysis showed that hypoalbuminemia (p=0.02), anemia (p=0.03), low platelet count (p=0.0009) and history of depression (p=0.01) were associated with all-cause mortality and non-fatal CV events were associated with receiving a second HSCT (p=0.006). Conclusions: Nutritional status and anemia were associated with all-cause mortality and second HSCT was a risk factor for future CV events in patients undergoing HSCT. Thus, oncologists should carefully monitor cancer patients, particularly after second HSCT, and consult with cardiologists.
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Morikawa et al. (2022) conducted a cohort in Hematological malignancies and breast cancer (n=490). Clinical and nutritional risk factors (e.g., hypoalbuminemia, anemia, second HSCT) vs. Absence of risk factors was evaluated on All-cause death, CV death and non-fatal CV events. Hypoalbuminemia, anemia, low platelets, and depression predicted all-cause mortality, while a second HSCT was associated with non-fatal cardiovascular events (P=0.006).
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