Introduction: Allogeneic haematopetic stem cell transplantation (allo-HSCT) is a potential curative therapy for young sufferers of hematological malignant and non malignant diseases. This intensive proceedure usually involves pretransplantation myeloablative chemotherapy and / or radiation therapy, both well documented to cause adverse effects to the heart. In addition, allo-HSCT patients are at risk of graft-versus-host-disease (GVHD).
Purpose: In the last decade there has been increasing awareness of heart related disease in survivors of cancer therapy. The main aim of this study is to describe the total burden of the cardiovascular late effects in young survivors of allo-HSCT.
Methods: This cross sectional, multidisciplinary survey was conducted between 2013 and 2016. The study included, 104 individuals, of whom 53.8% were female. Age at allo-HSCT was (mean±SD) 17.8±9.6 years. Age at follow-up was 35.0±11.7 years, and follow-up time from allo-HSCT was 17.2±5.6 years. The majority (98,1%) of individuals received myeloablative chemotherapy, 12.5% received radiation therapy and 1.9% received neither. Cardiovascular function was evaluated by comprehensive echocardiography (GE E9), including Speckle Tracking (2DSTE) and three dimensional echocardiography (3D). Left ventricular systolic dysfunction was defined by left ventricular ejection fraction (2D EF) ≤53% and Global Longitudinal Strain (GLS) ≤-17 (as recommended by the EACVI).
Results: LV systolic dysfunction defined by either by 2D EF ≤53% or GLS≤-17 or both was observed in 48.1%. The average 2D EF was 55.2±5.8%. 2D EF ≤53% was found in 35.6% of patients. Evaluation with GLS gave an average of -17.5±2.2% and 32.7% of the patients had a GLS ≤-17%. In 21.2% of the patients, a combination of GLS ≤-17% and 2D EF ≤53% was found.
Conclusion: Left ventricle systolic dysfunction is highly prevalent in long term survivors after allo-HSCT. These patients may be asymptomatic and unaware of their potential risk. Monitoring and screening regimes including echocardiography are important in allo-HSCT patients to ensure early detection of heart disease, early medical intervention and prevention against progressive heart failure.