Key result
Allogeneic hematopoietic cell transplantation rapidly accelerated cardiovascular aging, significantly reducing bodyweight-indexed peak oxygen uptake by a net difference of 4.5 ml/kg/min over 3 months compared to healthy controls.
Why the study?
Long-term survivors of allo-HCT face increased cardiovascular morbidity and mortality, but the short-term impact of allo-HCT on cardiovascular function remained unclear.
Does allogeneic hematopoietic cell transplantation reduce VO2peak and cardiac reserve in patients with hematological malignancy compared to healthy controls?
Cohort (n=38)
No
Does allogeneic hematopoietic cell transplantation reduce VO2peak and cardiac reserve in patients with hematological malignancy compared to healthy controls?
Allo-HCT rapidly accelerates cardiovascular aging, severely impairing VO2peak and cardiac reserve within 3 months, highlighting the need for early preventive interventions.
Allo-HCT impairs VO2 peak and cardiac reserve within 3 months; leaves open whether early interventions prevent accelerated aging in survivors.
Introduction Allogeneic hematopoietic cell transplantation (allo-HCT) offers a potential cure for high-risk hematological malignancy; however, long-term survivors experience increased cardiovascular morbidity and mortality. It is unclear how allo-HCT impacts cardiovascular function in the short-term. Thus, this 3-month prospective study sought to evaluate the short-term cardiovascular impact of allo-HCT in hematological cancer patients, compared to an age-matched non-cancer control group. Methods Before and ~3-months following allo-HCT, 17 hematological cancer patients (45 ± 18 years) underwent cardiopulmonary exercise testing to quantify peak oxygen uptake (VO 2 peak)—a measure of integrative cardiovascular function. Then, to determine the degree to which changes in VO 2 peak are mediated by cardiac vs. non-cardiac factors, participants underwent exercise cardiac MRI (cardiac reserve), resting echocardiography (left-ventricular ejection fraction [LVEF], global longitudinal strain [GLS]), dual-energy x-ray absorptiometry (lean [LM] and fat mass [FM]), blood pressure (BP) assessment, hemoglobin sampling, and arteriovenous oxygen difference (a-vO 2 diff) estimation via the Fick equation. Twelve controls (43 ± 13 years) underwent identical testing at equivalent baseline and 3-month time intervals. Results S ignificant group-by-time interactions were observed for absolute VO 2 peak ( p = 0.006), bodyweight-indexed VO 2 peak ( p = 0.015), LM ( p = 0.001) and cardiac reserve ( p = 0.019), which were driven by 26, 24, 6, and 26% reductions in the allo-HCT group (all p ≤ 0.001), respectively, as no significant changes were observed in the age-matched control group. No significant group-by-time interactions were observed for LVEF, GLS, FM, hemoglobin, BP or a-vO 2 diff, though a-vO 2 diff declined 12% in allo-HCT ( p = 0.028). Conclusion In summary, allo-HCT severely impairs VO 2 peak, reflecting central and peripheral dysfunction. These results indicate allo-HCT rapidly accelerates cardiovascular aging and reinforces the need for early preventive cardiovascular intervention in this high-risk group.
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Dillon et al. (2022) conducted a cohort in Hematological malignancy (n=38). Allogeneic hematopoietic cell transplantation (allo-HCT) vs. Age-matched non-cancer controls was evaluated on Change in bodyweight-indexed peak oxygen uptake (VO2peak) at 3 months (MD -4.5, 95% CI -8.1, -0.9, p=0.015). Allogeneic hematopoietic cell transplantation rapidly accelerated cardiovascular aging, significantly reducing bodyweight-indexed peak oxygen uptake by a net difference of 4.5 ml/kg/min over 3 months compared to healthy controls.
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