Best of the Best Oral Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2020

Impact of Allogeneic Stem Cell Transplant on the cardiovascular health of haematological cancer patients (#22)

Hayley T Dillon 1 2 , Bronwyn A Kingwell 2 3 , Yuki Horne-Okano 2 4 , Robin Daly 1 , Steve Fraser 1 , David Dunstan 2 , André La Gerche 2 , Erin J Howden 2
  1. Institute for Physical Activity and Nutrition, Deakin University, Melbourne, VIC, AU
  2. Baker Institute, Melbourne, VIC, AU
  3. CSL, Melbourne, VIC, AU
  4. Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, AU

Introduction: Allogeneic stem cell transplantation (SCT) is a potentially lifesaving procedure for patients with haematological cancers. However, the associated bed rest, cardiotoxic therapies, and the cancer itself places survivors at a ~4-fold increased risk of cardiovascular (CV) mortality. No studies have prospectively evaluated the effects of SCT on CV function. Thus, we sought to evaluate the short-term impact of SCT on CV function relative to a group of non-cancer controls.

Methods: Twenty-six haematological cancer patients scheduled for SCT (SCT, 48±17yrs) and twelve sex-matched controls (43±13yrs) were recruited. The groups were not significantly different in age. Prior to and 3-months following SCT, patients underwent a cardiopulmonary exercise test to quantify VO2peak, a DXA scan to assess lean body mass (LBM) and percentage body fat (%BF) and an echocardiogram to assess left ventricular ejection fraction (LVEF) and global longitudinal strain (GLS). Controls underwent identical testing at two-time points ~3-months apart.

Results: At baseline, cardiac function (LVEF) and body composition (LBM, %BF) were similar between groups, but GLS (18.3±0.4 vs 20.2±0.7%, p=0.001) and VO2peak (21.3±1.5 vs 34.9±2.4 ml/kg/min, p<0.001) were lower in SCT. Seventeen SCT patients completed follow-up (n=7 deceased, n=2 lost to follow-up). At follow-up, VO2peak was reduced by 19% in SCT compared to 2% in the controls (SCT: 21.3±1.5 to 16.5±1.4ml/kg/min, Controls: 34.9±2.4 to 34.2±2.0; gp×time p=0.03). LBM reduced by 6% in SCT compared to 0% in the controls (51.7±2.3 to 48.6±2.2kg 47.7±3.6 to 47.7±3.4kg; gp×time p=0.004). There was no statistically significant change in LVEF, GLS and %BF (gp×time p=0.3, p=0.5, p=0.5, respectively).

Conclusion: Despite no marked reductions in global cardiac function following allogeneic SCT, survivors demonstrated marked reductions in LBM and VO2peak. Indeed, VO2peak was severely impaired at follow-up equivalent to 50% of the controls. Whether decline in VO2peak is associated with survival could not be determined.