Venous Thromboembolism in Autologous Blood or Marrow Transplantation Survivors: A Report from the Blood or Marrow Transplant Survivor Study

Gangaraju, Radhika; Chen, Yanjun; Hageman, Lindsey; Wu, Jessica; Francisco, Liton; Battles, Kevin; Kung, Michelle; Ness, Emily; Parman, Mariel; Weisdorf, Daniel J.; Forman, Stephen J.; Arora, Mukta; Armenian, Saro H.; Bhatia, Smita

doi:10.1016/j.bbmt.2019.06.032

Cited by 9 publications

(7 citation statements)

References 22 publications

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“…The acute and long-term CV toxicities following hematopoietic stem cell transplantation (HSCT) are increasingly recognized as an important factor in the prognosis of stem cell recipients. 29 94…”

Section: Hematopoietic Stem Cell Transplantationmentioning

confidence: 99%

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Cardio-Oncology: A New Discipline in Medicine and Its Relevance to Hematology

Spannbauer,

Bergler-Klein

2024

Hamostaseologie

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Cardio-oncology, a burgeoning subspecialty, addresses the complex interplay between cardiology and oncology, particularly in light of increased cardiovascular (CV) disease mortality in cancer patients. This review provides a comprehensive overview of cardio-oncology with a focus on the therapies used in hematological malignancies. We explore the bidirectional relationship between heart failure and cancer, emphasizing the need for collaborative care. The review discusses risk stratification, highlighting the importance of baseline CV risk assessment and personalized surveillance regimens. Primary and secondary prevention strategies, including pharmacological interventions, are outlined. The review also delves into the cardiotoxicity associated with hematological cancer therapies, focusing on anthracyclines, Bruton kinase inhibitors, BCR-ABL tyrosine kinase inhibitors, CAR-T cell therapy, immune checkpoint inhibitors, multiple myeloma treatments, and hematopoietic stem cell transplantation. We then highlight the high risk of venous and arterial thromboembolisms in cancer patients and the challenges of anticoagulation management in cardio-oncology. Finally, the review touches on the importance of long-term follow-up and appropriate screening in cancer survivors at high risk of CV morbidity and mortality, based on their CV risk profile and the type and dose of cardiotoxic therapies they received such as anthracyclines or high radiation doses.

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Section: Hematopoietic Stem Cell Transplantationmentioning

confidence: 99%

“…The risk for the development of CAD scales with the presence and control of CV risk factors at the time of HSCT, as well as radiation exposure. 94 95…”

Section: Hematopoietic Stem Cell Transplantationmentioning

confidence: 99%

Cardio-Oncology: A New Discipline in Medicine and Its Relevance to Hematology

Spannbauer,

Bergler-Klein

2024

Hamostaseologie

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“…In contrast, among long-term allogeneic survivors, male sex has been associated with VTE, although no difference by sex was seen in autologous HCT survivors. 84,94 The reason for these differences is not entirely clear but may be based on a different set of risk factors for thrombosis in the immediate post-HCT setting (eg, immobility, central venous catheter), compared with longer-term survivors (eg, chronic GVHD, lifestyle factors), as well as lower overall rates of thrombosis in long-term autologous survivors. As thrombosis is clearly linked to worse outcomes in HCT patients, further investigation into sex-based differences is warranted.…”

Section: Hematopoietic Cell Transplantmentioning

confidence: 99%

“…81 Venous thromboembolism (VTE), in contrast, is common in HCT survivors, particularly in those that develop chronic graft-versus-host disease (GVHD) and those with plasma cell diseases (who may continue to receive thrombogenic anticancer therapies) and is associated with adverse outcomes. 75,83,84 While several sex-based differences in CVD have been described in the general population, the impact of sex in transplant and subsequent CVD is not as well known.…”

Section: Introductionmentioning

confidence: 99%

Sex-Specific Cardiovascular Risks of Cancer and Its Therapies

Wilcox

Rotz

Mullen

et al. 2022

Circulation Research

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In both cardiovascular disease and cancer, there are established sex-based differences in prevalence and outcomes. Males and females may also differ in terms of risk of cardiotoxicity following cancer therapy, including heart failure, cardiomyopathy, atherosclerosis, thromboembolism, arrhythmias, and myocarditis. Here, we describe sex-based differences in the epidemiology and pathophysiology of cardiotoxicity associated with anthracyclines, hematopoietic stem cell transplant (HCT), hormone therapy and immune therapy. Relative to males, the risk of anthracycline-induced cardiotoxicity is higher in prepubertal females, lower in premenopausal females, and similar in postmenopausal females. For autologous hematopoietic cell transplant, several studies suggest an increased risk of late heart failure in female lymphoma patients, but sex-based differences have not been shown for allogeneic hematopoietic cell transplant. Hormone therapies including GnRH (gonadotropin-releasing hormone) modulators, androgen receptor antagonists, selective estrogen receptor modulators, and aromatase inhibitors are associated with cardiotoxicity, including arrhythmia and venous thromboembolism. However, sex-based differences have not yet been elucidated. Evaluation of sex differences in cardiotoxicity related to immune therapy is limited, in part, due to low participation of females in relevant clinical trials. However, some studies suggest that females are at increased risk of immune checkpoint inhibitor myocarditis, although this has not been consistently demonstrated. For each of the aforementioned cancer therapies, we consider sex-based differences according to cardiotoxicity management. We identify knowledge gaps to guide future mechanistic and prospective clinical studies. Furthering our understanding of sex-based differences in cancer therapy cardiotoxicity can advance the development of targeted preventive and therapeutic cardioprotective strategies.

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“…6 In addition to risks of bleeding, VTE after HCT can result in increased health care-associated costs and platelet transfusion utilization 7 and has independently been associated with increased nonrelapse mortality. 8,9 Given the heightened risk of thrombosis and bleeding in allogeneic HCT patients, ongoing uncertainty exists regarding optimal timing and implementation of thromboprophylaxis. A retrospective analysis evaluating time to bleeding and recurrent VTE in patients with hematologic malignancies found that clinically significant bleeding occurred predominantly within the first 30 days after the onset of severe thrombocytopenia, whereas most recurrent VTE occurred after this.…”

Section: Introductionmentioning

confidence: 99%

HIGH-2-LOW risk model to predict venous thromboembolism in allogeneic transplant patients after platelet engraftment

Martens

Costa²,

Amos

et al. 2021

Blood Advances

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Venous thromboembolism (VTE) after allogeneic hematopoietic cell transplantation (HCT) is a significant treatment-associated complication, although optimal timing of thromboprophylaxis remains uncertain when weighing concurrent risks of bleeding. We aimed to derive and internally validate a risk assessment model (RAM) using patients who underwent first allogeneic HCT from 2006 through 2015 (n = 1703). Index date was defined as the 30th day after transplant, at which point we estimated >75% of patients would have achieved platelet engraftment >50 × 109/L. Stepwise logistic regression modeling was used for model development, and internal validation was achieved by fitting a logistic regression model with 1000 bootstrapped resamples to estimate the optimism-corrected c-statistic. The final RAM, “HIGH-2-LOW,” included 7 predictors obtained at 30 days after transplant: History of catheter-related deep venous thrombosis (DVT), Inpatient at day 30, Graft-versus-host disease grade 3 to 4, History of pulmonary embolism or lower-extremity DVT, Lymphoma diagnosis, Obesity with body mass index ≥35 kg/m2, and White blood cell count ≥11 × 109/L. Approximately 16% of patients were stratified as high risk, with incident VTE rate of 10.3% at 100 days compared with 1.5% for those at low risk. VTE odds ratios at 100 days were 5.87 (95% confidence interval [CI], 2.98-11.57) and 2.71 (95% CI, 1.38-5.35) in the high- and intermediate-risk vs low-risk groups, respectively. HIGH-2-LOW model serves as a novel and potentially clinically meaningful tool to identify high-risk allogeneic HCT patients who may benefit from early thromboprophylaxis after platelet engraftment.

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Venous Thromboembolism in Autologous Blood or Marrow Transplantation Survivors: A Report from the Blood or Marrow Transplant Survivor Study

Cited by 9 publications

References 22 publications

Cardio-Oncology: A New Discipline in Medicine and Its Relevance to Hematology

Cardio-Oncology: A New Discipline in Medicine and Its Relevance to Hematology

Sex-Specific Cardiovascular Risks of Cancer and Its Therapies

HIGH-2-LOW risk model to predict venous thromboembolism in allogeneic transplant patients after platelet engraftment

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