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Published on: January 28, 2020
Retrospective outcome data for hematopoietic stem cell transplantation in patients with concurrent coronary artery
Elizabeth E Stillwell1, Jeffrey D Wessler, Brian J Rebolledo
1Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York, USA.
Insights
Patients with coronary artery disease (CAD) can safely undergo hematopoietic stem cell transplantation (HSCT). This study found no increased risks for CAD patients compared to those without CAD, suggesting HSCT is a viable option for this population.
Area of Science:
- Hematology
- Cardiology
- Transplantation Medicine
Background:
- Hematopoietic stem cell transplantation (HSCT) imposes significant physiological stress.
- The safety of HSCT for patients with pre-existing coronary artery disease (CAD) is not well-established.
- Limited data exists on the transplantation risks associated with underlying CAD.
Purpose of the Study:
- To evaluate the safety and outcomes of HSCT in patients with pre-existing coronary artery disease (CAD).
- To compare HSCT outcomes between patients with CAD and a control group without CAD.
Main Methods:
- Retrospective analysis of 72 HSCT procedures in 69 patients with CAD.
- Comparison of outcomes with 1183 HSCT procedures in 1109 patients without CAD.
- Data collection included prior cardiac interventions (PCI, MI, CABG) and transplant characteristics.
Main Results:
- No significant differences in treatment-related mortality, 1-year mortality, or urgent ICU admissions between CAD and control groups.
- Similar lengths of stay were observed between the two groups.
- Cancer diagnoses were comparable across both patient cohorts.
Conclusions:
- Patients with pre-existing coronary artery disease (CAD) can undergo hematopoietic stem cell transplantation (HSCT) safely.
- Underlying CAD does not appear to significantly increase transplantation-related risks.
- HSCT is a feasible treatment option for select patients with both CAD and hematologic malignancies.
Abstract:
Hematopoietic stem cell transplantation (HSCT) represents an extended period of physiologic stress. It is unknown whether patients with pre-existing coronary artery disease (CAD) may be poor transplant candidates. There are no data analyzing the risk of transplantation in this population. Sixty-nine patients with CAD who underwent 72 transplantations, autologous and allogeneic, were identified retrospectively. Fifty-five percent of these patients had prior percutaneous coronary intervention, 42% had verifiable history of myocardial infarction, and 23% had prior coronary artery bypass grafting. Outcomes were compared to 1109 patients without established CAD who underwent 1183 transplants during the same time period. Cancer diagnoses in the 2 groups were similar, predominantly lymphoma, multiple myeloma, and leukemia. There was no significant difference between the CAD group and the control group with respect to type of transplant (autologous 68% versus 64%, P = .612, myeloablative 86% versus 85%, P = .867). Treatment-related mortality was no different in the CAD group versus the control group (5.6% versus 4.9%, P = .777), nor were there differences in mortality at 1 year (15.3% versus 16.6%, P = .871), urgent intensive care unit admission (11.1% versus 9.9%, P = .686), or length of stay (25.5 days versus 28.4 days, P = .195). These findings suggest many patients with underlying coronary artery disease may be safely managed through hematopoietic stem cell transplantation.
