Impact of blood pressure early after allogeneic hematopoietic cell transplantation on clinical outcomes
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ORIGINAL ARTICLE
Impact of blood pressure early after allogeneic hematopoietic cell transplantation on clinical outcomes Masaharu Tamaki 1 & Hideki Nakasone 1 & Shunto Kawamura 1 & Junko Takeshita 1 & Nozomu Yoshino 1 & Yukiko Misaki 1 & Kazuki Yoshimura 1 & Ayumi Gomyo 1 & Aki Tanihara 1 & Machiko Kusuda 1 & Yu Akahoshi 1 & Koji Kawamura 1 & Shun-ichi Kimura 1 & Shinichi Kako 1 & Yoshinobu Kanda 1 Received: 30 August 2019 / Accepted: 8 March 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Allogeneic hematopoietic transplantation (allo-HCT) is still associated with significant morbidity and mortality, and risk stratification is critical. In this study, we analyzed the relationship between blood pressure control early after allo-HCT and survival outcomes. All patients who survived longer than 28 days after allo-HCT at our center between June 2007 and June 2018 (n = 353) were included, and the average systolic blood pressure (asBP) from 1 to 28 days after allo-HCT was calculated. According to the results of a ROC curve analysis, an asBP of 131 mmHg was defined as a cut-off value between high and low asBP groups. Nonrelapse mortality (NRM) and OS were significantly inferior in the high asBP group (2-year-NRM 28.0% vs 11.1%, P < 0.001; 2year-OS 46.7% vs 65.7%, P = 0.001). In addition, baseline asBP before commencement of the conditioning regimen and elevation of asBP (asBP – baseline asBP) were both associated with inferior NRM. While these results were also observed in the younger patients (≤ 50 years), no relationship was observed in the older patients (> 50 years). High blood pressure within 28 days after allo-HCT was associated with inferior survival outcomes, especially in patients younger than 50 years. Keywords Blood pressure . Hypertension . Non-relapse mortality . Allogeneic transplantation
Introduction Although allogeneic hematopoietic cell transplantation (alloHCT) is one of the most important curative treatments for various hematological disorders, it is still associated with significant morbidity and mortality. Risk stratification and prophylaxis against serious complications are critical for improving survival outcomes [1, 2]. The hematopoietic cell transplantation comorbidity index (HCT-CI) is one of the most prevalent risk-stratification tools for allo-HCT, and includes several cardiovascular risk factors such as lower ejection fraction and a past medical history of diabetes mellitus [3, 4]. In Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00277-020-03990-y) contains supplementary material, which is available to authorized users. * Yoshinobu Kanda [email protected] 1
Division of Hematology, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho Omiya-ku, Saitama 330-8503, Japan
general, hypertension is a well-known risk factor for cardiovascular diseases and renal failure. However, it is not included in the HCT-CI [5–7]. In the early phase following allo-HCT, the recipient’s blood pressure is likely to be e
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