All ETDs from UAB

Advisory Committee Chair

Emily Levitan

Advisory Committee Members

Smita Bhatia

Ravi Bhatia

Shakia Hardy

Document Type


Date of Award


Degree Name by School

Master of Science (MS) School of Public Health


Background: Blood or marrow transplant (BMT) recipients are vulnerable to accelerated atherosclerosis due to prior exposure to chemotherapy and radiation, and consequent long-term cardiovascular morbidity, such as coronary heart disease (CHD). A comprehensive evaluation of the risk of late-occurring CHD in adult BMT survivors and the associated risk factors has not been performed. Patients and Methods: Using the Blood or Marrow Transplant Survivor Study (BMTSS), we analyzed the incidence and risk factors for CHD in patients who underwent BMT between 1974 and 2014, and survived ≥2 years. The risk of CHD was examined in BMT survivors as compared to 1,131 siblings. Results: The study included 3,479 BMT survivors; 50.3% had received an allogeneic BMT, and 71.4% were non-Hispanic whites. Median age at study participation was 59 years (interquartile range [IQR]: 48-66 years) for BMT survivors and 57 years (IQR: 46-64 years) for siblings. Conditional on surviving ≥2 years after BMT, the cumulative incidence of CHD was 6.5±0.7% at 20 years. Allogeneic BMT survivors were at a 7.2-fold higher risk of reporting CHD as compared to siblings (95%CI: 4.0-13.0, p<0.0001), and autologous BMT recipients were at a 11.7-fold higher risk (95%CI: 6.8-20.2, p<0.0001). Increasing age at BMT (HR=1.04/year, 95%CI: 1.01-1.07, p=0.003), male sex (HR=2.08, 95%CI: 1.12-3.88, p=0.021), and history of cardiovascular risk factors iv including diabetes, hypertension or dyslipidemia (HR=3.55, 95%CI: 1.70-7.42, p=0.0008) were associated with increased CHD risk in allogeneic BMT survivors. In autologous BMT survivors, increasing age at BMT (HR=1.06/y, 95%CI: 1.03-1.09, p<0.0001), male sex (HR=2.43, 95%CI: 1.38-4.27, p=0.002), and history of pre-BMT chest radiation (HR=3.24, 95%CI: 1.48-7.11, p=0.003) were significantly associated with CHD. Conclusion: BMT survivors are at an increased risk of developing CHD when compared to unaffected siblings. Our study also identified subgroups among BMT survivors at increased risk of CHD. These findings suggest a need for increased awareness of CHD as a late complication of BMT, such that aggressive management of cardiovascular risk factors can be instituted among those at highest risk.

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