Incidence and Risk Factors for Metabolic Syndrome in Allogeneic Hematopoietic Stem Cell Transplant (HSCT) Recipients- a Tertiary Care Center Experience

INTRODUCTION:  Metabolic syndrome could be a complication of HSCT. Several mechanisms, including conditioning regimen-mediated damage to the neurohormonal system and vascular endothelium, and the immunological and inflammatory effects of the allogeneic graft and subsequent GVHD and its therapy may play a role.

METHODS: Retrospective review of medical records of 164 survivors of allogeneic HSCT between 1993 and 2010, currently followed at the long term follow up clinic to determine the incidence and risk factors associated with metabolic syndrome. Metabolic syndrome was defined as clustering of risk factors for cardiovascular disease characterized by abdominal obesity, atherogenic dyslipidemia, elevated blood pressure, insulin resistance, and a proinflammatory and prothrombotic state.

RESULTS: Patient characteristics are summarized in table 1. The prevalence of metabolic syndrome was 7% in our patient cohort. Six patients had BMI >25, 4 between 20 and 25, one <20. The prevalence rates of hypertriglyceridemia and microalbuminuria were 91 % and 64% respectively. Other derangements in the lipid profile included elevated total cholesterol, low HDL and high to normal LDL in 9 patients. Thirty-six percent of the patients had hypothyroidism and insulin resistance. Three out of the 11 survivors with metabolic syndrome had hypertension and were being treated for it. 73 % of the patients are being followed up in preventive cardiology or endocrinology clinic.

CONCLUSIONS:  The prevalence of metabolic syndrome in our study cohort was more than the general pediatric population (3.3%). Most of the patients who developed metabolic syndrome had been treated with radiation and had a diagnosis of hematological malignancy. Hypertriglyceridemia and microalbuminuria were clinical characteristics common to most patients.

 

Patient Characteristics	Number ( percentages) (n=11)
Age at Transplant (years) Median Range	6 0-15
Gender M F	4(36%) 7(64%)
Ethnicity Caucasian Hispanic Others	5 (45%) 5(45%) 1(9%)
Primary Diagnosis Malignancy Non-Malignancy	9(82%) 2(18%)
Transplant (HPCT) Characteristics
Donor Related Donor Alternative Donor	9(82%) 2(18%)
HLA Disparity 0-1   loci 2-3  loci 4-5 loci	11 0 0
Stem Cell Source PBSC BM Cord	6(55%) 4(36%) 1(9%)
Conditioning Myeloablative MAC Reduced Intensity RIC	11 0
Radiation TBI (12 Gy, 1.5 Gy fractions) Cranial Testicular Spinal	7 (64%) 4 (36%) 1 (9%) 1(9%)
GVHD prophylaxis Cyclosporine based Tacrolimus based + ATG + MTX	11 (100%) 0 (0%) 2 (18%) 8 (73%)
Transplant Complications
aGVHD	2 (18%)
cGVHD	5 (45%)
GVHD treatment Steroids ECP Others	6 (54%) 4 (36%) 6 (54%)