Work

Diabetes Mellitus (DM) and Hypertension (HTN) in Adult And Pediatric Survivors of Allogeneic Hematopoietic-Cell Transplantation (HCT)

Year: 2009

Type: article

Abstract: DM and HTN are frequent early complications of allogeneic HCT; however, their long-term outcome is not well known. We conducted a retrospective cohort study to describe the risk factors and natural history of post-transplant DM and HTN. Consecutive allogeneic HCT recipients from 2003–2005 were included in this study if they had survived >1 year post-transplant and had not received a previous HCT. DM and HTN were defined by published adult and pediatric guidelines. The final cohort consisted of 180 patients (adult [≥18 years] 106, pediatric [<18 years] 74); the median age was 27 (range 0.2–69) years. Before HCT, 13% had DM, 9% had HTN, 18% smoked and 19% were obese. Pediatric patients were less likely to have pre-transplant DM, HTN, smoking history or high-risk disease and more likely to receive myeloablative (MA) conditioning. MA conditioning (Cy + 1320 cGy TBI ± Flu) was given to 66% recipients, remainder received non-MA conditioning (Cy + Flu + 200 cGy TBI). All patients are followed until at least 2 years post-HCT at our center; among these 1 year survivors, 156 (87%) were alive at 2 years. Acute or chronic graft-versus-host disease occurred in 118 (66%) patients; of these, 34% received cyclosporine (CSA) for >12 months and 47% received prednisone for >12 months. Within 2-years after HCT, 54 (30%) had DM while 126 (70%) had HTN. Rates were similar for adult (DM 30%, HTN 68%) and pediatric (DM 30%, HTN 73%) recipients. At 2 years post-HCT, 12% had persistent DM while 39% had persistent HTN. Increasing cumulative dose of corticosteroids increased the likelihood of having persistent DM at 2 years post-transplant (no steroids 7%, ≤ 0.25 mg/kg/d 13%, >0.25 mg/kg/d 27%, p = 0.02); such an association was not observed for HTN. On multivariate analyses, risk factors for DM included history of DM pre-HCT (relative risk [RR] 5.0 [95% CI, 2.8–8.9]) and prednisone exposure (RR 2.4 [1.3–4.5]), while no predictive factors for resolution of post-HCT DM were identified. CSA exposure was the only risk factor for post-HCT HTN (RR 1.6 [1.1–2.5]), while history of HTN pre-HCT was predictive for persistent HTN beyond 2 years (RR 3.07 [1.1–8.3]). DM and HTN are frequent among survivors of adult and pediatric allogeneic HCT and can persist for an extended period of time after transplantation. Continued monitoring and treatment of DM and HTN is necessary in HCT survivors, especially if survivors have been exposed to corticosteroids.

Source: Transplantation and Cellular Therapy

DOI: 10.1016/j.bbmt.2008.12.160

Authors: N.S. Majhail, T.R. Challa, D.A. Mulrooney, K.S. Baker, L.J. Burns

Institution: University of Minnesota

Language: English

Topic: Hematopoietic Stem Cell Transplantation

Subfield: Hematology

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: hybrid

Estimated APC paid: $3,650