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,
Authors: Pophali Priyanka A , Chawla Kamna , Koklanaris Eleftheria K. , Antia Avan , Chawla Simar , Ito Sawa , Klotz Jeffrey K. , Le Robert Q. , Barrett A. John , Battiwalla Minoo 
Published: October 2019

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.Percentage of increase in cardiovascular risk factors from pre-transplant baseline at follow-up5yrs (%)10yrs (%)Diabetes8101005Hypertension292563CRP (as a continuous variable)441721BMI (as a continuous variable)210

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No relevant conflicts of interest to declare.