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Published on: December 8, 2023
Hyperlipidemia after allogeneic stem cell transplantation: prevalence, risk factors, and impact on prognosis
Yuki Kagoya1, Sachiko Seo, Yasuhito Nannya
1Department of Hematology & Oncology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
Insights
Hyperlipidemia, a late complication of allogeneic stem cell transplantation (SCT), is linked to chronic graft-versus-host disease (GVHD). Hypercholesterolemia may indicate better disease control post-SCT.
Area of Science:
- Hematology
- Oncology
- Transplantation Medicine
Background:
- Hyperlipidemia is a recognized late complication following allogeneic stem cell transplantation (SCT).
- Potential causes like chronic graft-versus-host disease (GVHD) and calcineurin inhibitors are suspected but not well-studied.
- The prevalence, risk factors, and prognostic impact of hyperlipidemia post-SCT require further investigation.
Purpose of the Study:
- To investigate the prevalence, risk factors, and prognostic significance of hyperlipidemia after allogeneic SCT.
- To explore the association between hyperlipidemia and chronic GVHD, immunosuppressive agents, and patient outcomes.
Main Methods:
- Retrospective analysis of 194 patients undergoing allogeneic SCT between 1995 and 2008.
- Survival of over 100 days post-SCT was a criterion for inclusion.
- Multivariate analysis was used to identify risk factors and prognostic impacts.
Main Results:
- Hypercholesterolemia (≥240 mg/dL) and hypertriglyceridemia (≥200 mg/dL) affected 42.8% and 50.8% of patients, respectively.
- Chronic GVHD and steroid use were independently associated with hypercholesterolemia; calcineurin inhibitors were not.
- Hypercholesterolemia showed a trend towards a lower relapse rate (HR: 0.44, p=0.07) without impacting non-relapse mortality or overall survival.
Conclusions:
- Hypercholesterolemia is a common complication after allogeneic SCT, often associated with chronic GVHD.
- The presence of hypercholesterolemia may suggest improved control of the underlying disease post-transplantation.
- Further research is needed to elucidate the mechanisms and implications of hyperlipidemia in SCT survivors.
Abstract:
Hyperlipidemia is one of the late complications after allogeneic stem cell transplantation (SCT). Although intrahepatic cholestasis caused by chronic graft-versus-host disease (GVHD) or calcineurin inhibitors has been considered as possible etiologies, its prevalence, risk factors, and impact on prognosis have not been investigated well. We performed a retrospective analysis of 194 patients who underwent allogeneic SCT between 1995 and 2008 in our institute and survived more than 100 d after SCT. Overall, 83 (42.8%) and 99 (50.8%) patients developed hypercholesterolemia (≥240 mg/dL) and hypertriglyceridemia (≥200 mg/dL), respectively. In multivariate analysis, the development of chronic GVHD (hazard ratio [HR] 2.04, p < 0.05) and steroid use (HR 2.24, p < 0.01) were independently associated with hypercholesterolemia, while administration of calcineurin inhibitors was not. As for the prognostic impact, multivariate analysis showed that the patients with hypercholesterolemia had a tendency of lower rate of relapse (HR: 0.44, p = 0.07). There was no difference in non-relapse mortality or overall survival between the groups. In conclusion, the development of hypercholesterolemia is regarded as one of the symptoms accompanied with chronic GVHD and might indicate a better control of the primary disease.
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