Читать книгу Blood and Marrow Transplantation Long Term Management - Группа авторов - Страница 99

About one‐third of HCT patients are at increased risk of developing known cardiovascular risk factors (CVRFs) [57]. Acute GVHD and TBI have been reported to be risk factors specific to HCT along with the well‐recognized cardiotoxic chemotherapies (cyclophosphamide, anthracyclines, trastuzumab, etc.) and mediastinal radiation. The estimated prevalence of long‐term cardiovascular complications has been reported to be approximately 5% at 5 years and 9% at 15 years [41, 58]. cGVHD uniquely poses a significantly increased risk for the development of CVRFs due to the toxicity of drugs. Corticosteroids and CNI increase the risk of both diabetes and hypertension, whereas sirolimus increases the risks of dyslipidemias. CVRFs should be minimized with aggressive treatment strategies and with modification of preventable CVRFs (e.g., smoking, unhealthy diets). A recent study identified CELF4 polymorphisms associated with anthracycline‐related cardiomyopathy [72]. Routine post‐HCT care should incorporate measurements of blood pressure, nutritional counseling, obesity control, counseling for smoking cessation, and control of diabetes. Electrocardiogram/ echocardiography performance at yearly intervals may be necessary for high‐risk patients (e.g., those with CVRFs or anthracycline exposures).