Metabolic syndrome in long-term survivors after allogeneic hematopoietic stem cell transplantation

Česká verzia

Authors: Ľ. Harvanová ^1,2; L. Petríková ³; E. Bojtárová ¹; B. Žiaková ¹; M. Martišová ¹; V. Lábska ¹; M. Hrubiško ^1,2; A. Bátorová ¹; B. Mladosievičová ⁴
Authors place of work: Klinika hematológie a transfuziológie LF UK, LF SZU a UN Bratislava, Slovenská republika ¹; Katedra hematológie a transfuzológie, LF SZÚ, Bratislava, Slovenská republika ²; Klinika onkohematológie LF UK a NOÚ, Bratislava , Slovenská republika ³; Ústav patologickej fyziológie LF UK, Bratislava, Slovenská republika ⁴
Published in the journal: Klin Onkol 2022; 35(2): 132-138
Category: Original Articles
doi: https://doi.org/10.48095/ccko2022132

Summary

Background: Allogeneic hematopoietic stem cell transplantation (HSCT) offers potentially curative therapy for numerous malignant and non-malignant diseases. The number of survivors and length of follow-up after successful HSCT is continually increasing. Hematopoietic stem cell transplantation can induce damage of various organs and tissues – from minimal potentially progressive subclinical changes to life-threatening conditions. The aim of this thesis was the evaluation of the prevalence of metabolic syndrome (MS) among survivors of allogeneic HSCT. Patients and methods: We analyzed 74 patients with a median age at transplant of 35 years, who had been followed for a median of 5 years (2–23 years) after allogeneic HSCT. MS was defined according to the National Cholesterol Education Program’s Adult Treatment Panel III (NCEP ATP III) criteria and by the International Diabetes Federation (IDF) definition. Results: The prevalence of MS among HSCT recipients was 40.5% applying the NCEP ATP III definition and 39.2% the IDF, a 2.02-fold increase compared to the general Slovak population. MS was more common in men. The most common MS features were abdominal obesity, hypertriglyceridemia and hypertension. The lowest prevalence of MS was in the age group of 20–29 years; and the highest prevalence in the age group of 60–69 years. The 10-year cumulative incidence of MS was 32.5%. The most significant risk factor for MS was total body irradiation, positive family history and age > 40 years at HSCT. Seven patients (9.45%) developed cardiovascular complications. The median 10-year general cardiovascular risk scores for males and females were found to be 13.3% and 6.68%, respectively. Conclusions: Detected increased prevalence of metabolic syndrome after allogeneic HSCT in patients surviving more than 2 years after this procedure may provide next stimulus to promote longer follow-up studies and to design of interventions to prevent late effects among survivors of serious hematologic diseases.

Keywords:

metabolic syndrome – allogeneic hematopoietic stem cell transplantation – late effects

Zdroje

1. International Diabetes Federation. The IDF consensus worldwide definition of the metabolic syndrome. [online]. Available from: https: //www.idf.org.

2. Third report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Circulation 2002; 106 (25): 3143–3421.

3. Saklayen MG. The global epidemic of the metabolic syndrome. Curr Hypertens Rep 2018; 20 (2): 1–8. doi: 10.1007/s11906-018-0812-z.

4. Greenfield DM, Salooja N, Peczynski C et al. Metabolic syndrome and cardiovascular disease after haematopoietic cell transplantation (HCT) in adults: an EBMT cross-sectional non-interventional study. Bone Marrow Transplant 2021; 56 (11): 2820–2825.

5. Roziaková L, Bojtárová E, Mistrík M et al. Neskoré následky u pacientov liečených alogénnou transplantáciou kmeňových krvotvorných buniek. Klin Onkol 2011; 24 (6): 453–459.

6. Paris C, Yates L, Lama P et al. Evaluation of metabolic syndrome after hematopoietic stem cell transplantation in children and adolescents. Pediatr Blood Cancer 2012; 59 (2): 306–310. doi: 10.1002/pbc.24104.

7. Bajwa R, Skeens M, Garee A et al. Metabolic syndrome and endocrine dysfunctions after HSCT in children. Pediatr Transplant 2012; 16 (8): 872–878. doi: 10.1111/petr.12002.

8. Majhail NS, Flowers ME, Ness KK et al. High prevalence of metabolic syndrome after allogeneic hematopoietic cell transplantation. Bone Marrow Transplant 2009; 43 (1): 49–54. doi: 10.1038/bmt.2008.263.

9. Muhic E, Mathiesen S, Nielsen MM et al. Metabolic syndrome in male survivors of pediatric allogeneic hematopoietic stem cell transplantation: impact of total body irradiation, low-grade inflammation, and hypogonadism. Transplant Cell Ther 2021; 27 (9): 778.e1–778e.8. doi: 10.1016/j.jtct.2021.05.025.

10. Nuver J, Smit AJ, Postma A et al. The metabolic syndrome in long-term cancer survivors, an important target for secondary preventive measures. Cancer treatment reviews 2002; 28 (4): 195–214. doi: 10.1016/s0305-7372 (02) 00038-5.

11. Couriel DR, Saliba R, Escalón MP et al. Sirolimus in combination with tacrolimus and corticosteroids for the treatment of resistant chronic graft-versus-host disease. Br J Haematol 2005; 130 (3): 409–417. doi: 10.1111/j.1365-2141.2005.05616.x.

12. Airaghi L, Usardi P, Forti S et al. A comparison between metabolic syndrome post-hematopoietic stem cell transplantation and spontaneously occurring metabolic syndrome. J Endocrinol Invest 2011; 34 (1): 6–11. doi: 10.1007/BF03346702.

13. Galajda P, Mokáň M, Prídavková D et al. Prevalencia metabolického syndrómu na Slovensku. Interná Med. 2007; 7 (6): 325–331.

14. Miláček D, Volkovová K, Gajdoš M et al. A considerable proportion of metabolic syndrome-free adults from Bratislava Region, Slovakia, display an increased cardiometabolic burden. Can J Physiol Pharmacol 2021; 99 (9): 974–982. doi: 10.1139/cjpp-2020-0707.

15. Coronary heart disease risk calculator. [online]. Available from: http: //www.medcalc.com /heartrisk.html.

16. Guner Ozenen G, Aksoylar S, Goksen D et al. Metabolic syndrome and risk factors after hematopoietic stem cell transplantation in children and adolescents. J Pediatr Endocrinol Metab 2021; 34 (4): 485–493. doi: 10.1515/jpem-2020-0584.

17. Bielorai B, Weintraub Y, Hutt D et al. The metabolic syndrome and its components in pediatric survivors of allogeneic hematopoietic stem cell transplantation. Clin Transplant 2017; 31 (3). doi: 10.1111/ctr.12903.

18. Chow EJ, Simmons JH, Roth CL et al. Increased cardiometabolic traits in pediatric survivors of acute lymphoblastic leukemia treated with total body irradiation. Biol Blood Marrow Transplant 2010; 16 (12): 1674–1681. doi: 10.1016/j.bbmt.2010.05.016.

19. Oudin C, Simeoni MC, Sirvent N et al. Prevalence and risk factors of the metabolic syndrome in adult survivors of childhood leukemia. Blood 2011; 117 (17): 4442–4448. doi: 10.1182/blood-2010-09-304899.

20. Armenian SH, Sun CL, Vase T et al. Cardiovascular risk factors in hematopoietic cell transplantation survivors: role in development of subsequent cardiovascular disease. Blood 2012; 120 (23): 4505–4512. doi: 10.1182/blood-2012-06-437178.

21. Jurkovičová J. Hodnotenie celkového kardiovaskulárneho rizika. In: Jurkovičová J. Vieme zdravo žiť? Bratislava: Lekárska fakulta Univerzity Komenského 2005: 137–150.

22. Majhail NS, Rizzo JD, Lee SJ. Recommended screening and preventive practices in long-term survivors after hematopoietic stem cell transplantation. Biol Blood Marrow Transplant 2012; 18 (3): 348–371. doi: 10.1016/ j.bbmt.2011.12.519.

23. Polgreen LE, Thomas W, Macmillan ML et al. First phase insulin release and glucose tolerance in children with fanconi anemia after hematopoietic cell transplantation. Pediatr Blood Cancer 2009; 53 (2): 191–196. doi: 10.1002/pbc.22043.