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. 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.