Cardiovascular Management of Patients Undergoing Hematopoietic Stem Cell Transplantation: From Pretransplantation to...

Area of Science:

• Cardiology
• Hematology
• Oncology

Background:

• Hematopoietic stem cell transplantation (HSCT) offers curative potential for various disorders but is associated with significant cardiovascular risks, particularly in elderly patients or those with pre-existing cardiovascular conditions.
• Current pretransplantation cardiovascular evaluation lacks standardized guidelines, creating a need for comprehensive management strategies.
• Cardiovascular complications can arise during all phases of HSCT, from pretransplantation workup to long-term survivorship, impacting patient morbidity and mortality.

Purpose of the Study:

• To summarize existing data on transplantation-related cardiovascular complications.
• To provide evidence-based guidance for cardiovascular management throughout the entire HSCT process.
• To address the growing population of HSCT survivors and their long-term cardiovascular health.

Main Methods:

• Review and synthesis of current literature on cardiovascular complications associated with HSCT.
• Categorization of complications based on HSCT phases: pretransplantation, conditioning/infusion, immediate posttransplantation, and long-term survivorship.
• Development of a structured 4-step pretransplantation cardiovascular evaluation protocol: risk stratification, exclusion of high-risk disease, cardiac reserve assessment, and optimization.

Main Results:

• Common acute cardiovascular complications in adults include arrhythmias (e.g., atrial fibrillation) and acute heart failure.
• In pediatric patients, left ventricular systolic dysfunction and pericardial effusion are the most frequent complications.
• Influencing factors for complications include pretransplantation therapies, HSCT type, conditioning regimen, comorbidities, and patient age.

Conclusions:

• Standardized cardiovascular evaluation and management are crucial for patients undergoing HSCT.
• Long-term cardiovascular care for HSCT survivors should focus on risk factor optimization, vigilant monitoring, and prompt evaluation of cardiac symptoms.
• Further research is needed to refine risk stratification tools and develop evidence-based guidelines to enhance outcomes for HSCT recipients.