Cardiovascular Disease Risk Assessment and Management in Survivors of Allogeneic Hematopoietic Cell Transplantation

Abstract

Long-term survivors of allogeneic hematopoietic cell transplantation (HCT) are at greater risk for developing late effects, with increased risk of mortality compared to the general population. This includes a 2-3 fold increased risk of metabolic syndrome and cardiovascular disease. While screening and appropriate treatment for metabolic syndrome and CVD is recommended for long-term HCT survivors, specific guidelines in this high risk population is limited. The Cleveland Clinic Blood and Marrow Transplant Survivorship program was established in 2016 to improve the long-term care of transplant recipients. Patients are systematically evaluated at 100 days, and 1-, 2-, and 5-years post-HCT by an advanced practice practitioner (APP) in a consultative model, in which the visit is primarily focused on health maintenance and late effects. In an effort to improve our practice of CVD screening and prevention, we created specific guidelines focusing on the 4 core clinical measures of metabolic syndrome: increased body weight/visceral adiposity, elevated lipids, increased blood pressure, and hyperglycemia/insulin resistance. Table 1 shows our survivorship programs approach to evaluating CVD risk in allogeneic HCT survivors and the subsequent preventive and management recommendations, that are based on American College of Cardiology/American Heart Association guidelines. The recommendations were further modified to account for common challenges providers identify in the unique HCT population, such as multiple HCT medication interactions, organ dysfunction and graft versus host disease. In addition, we encourage patients to follow up with their primary care providers to continue management and monitoring. Education is also provided on healthy lifestyle changes including exercise recommendations and healthy eating. Specific goals and targets are reviewed with patients and their caregivers. Dieticians, physical therapy, smoking and tobacco cessation are available and offered when appropriate. We present a platform for guideline-driven and multidisciplinary approach to assessment, prevention and management of CVD risk-factors in allogeneic HCT survivors. Data is being collected to evaluate the impact of medication, education and the systematic management of these patients and overall incidents of CVD events.