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Cardiovascular risk factors and subclinical organ damage after hematopoietic stem cell transplantation in pediatric age

Bone Marrow Transplantation volume 53, pages 983–992 (2018)Cite this article

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Abstract

Advances in allogeneic hematopoietic stem cell transplantation (HSCT) in malignant and non-malignant diseases result in more long-term survivors, in whom cardiovascular (CV) disease is one leading non-cancer cause of death. This study aimed to evaluate risk factors and subclinical CV organ damage in survivors after HSCT in pediatric age. We enrolled 64 children in a cross-sectional approach 3.3 ± 3.1 years after HSCT. Anthropometric data, laboratory values, office and 24-h ambulatory blood pressure monitoring (ABPM) were evaluated, showing a high prevalence of obesity, hypertension and dyslipidemia. CV organ damage was determined by non-invasive measurements of aortic pulse wave velocity (PWV), left ventricular mass index (LVMI), and carotid intima media thickness (IMT). Increased IMT and elevated PWV reflecting subclinical vascular damage were detected in 48% (IMT) and 6% (PWV) of our population. For IMT, physical activity had a positive impact and was worsened by time after HSCT. Our results show a surprisingly high rate of subclinical CV organ damage and classical risk factors. Therefore, diagnosis and management of well-known CV risk factors belong to clinical care after HSCT.

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Acknowledgements

We would like to thank the participating patients and families for their support of this study, especially for their time and adherence. Many people were involved in patient care and organization of this study. Special thanks goes to the outpatient nurse staff and the study nurse team of the pediatric oncology and of pediatric nephology. We would like to thank the HSCT-team as well as the heads of the Depts. of Pediatric Oncology and Haematology at Hannover Medical School (Prof. C. Kratz) and the University of Essen (Prof. D. Reinhardt) for their support of this study. This work was supported by the German Ministry of Education and Research through the Integrated Research and Treatment Center Transplantation (ref. 01EO0802), by the Verein für krebskranke Kinder e.V., and by the Betreuungsnetzwerk für schwerkranke Kinder Hannover e.V.

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    Authors and Affiliations

    1. Department of Paediatric Kidney, Liver and Metabolic Diseases, MHH, Hannover, Germany

      Bianca Borchert-Mörlins, Nima Memaran, Ricarda Blöte, Elena Bauer & Anette Melk

    2. Department of Paediatric Hematooncology, MHH, Hannover, Germany

      Martin Sauer, Britta Maecker-Kolhoff & Karl-Walter Sykora

    3. Department of Nephrology, MHH, Hannover, Germany

      Bernhard M. W. Schmidt

    4. Department of Paediatric Hematooncology, Clinic for Paediatrics III, University Hospital Duisburg-Essen, Essen, Germany

      Rita Beier

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    Borchert-Mörlins, B., Memaran, N., Sauer, M. et al. Cardiovascular risk factors and subclinical organ damage after hematopoietic stem cell transplantation in pediatric age. Bone Marrow Transplant 53, 983–992 (2018). https://doi.org/10.1038/s41409-018-0104-x

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