Incidence and risk factors for early-onset hypertension after allogeneic hematopoietic stem cell transplantation in children.

BACKGROUND AND OBJECTIVES: Survivors of pediatric hematopoietic stem cell transplantation (HSCT) are at risk for developing hypertension. The objectives of this study are to evaluate the prevalence and risk factors of early onset hypertension during the engraftment period after HSCT. SUBJECTS AND METHODS: This is a retrospective study of 157 consecutive patients (mean age at HSCT: 9.1±5.1 years) who underwent HSCT for acute myeloid leukemia (n=47), acute lymphoblastic leukemia (n=43), severe aplastic anemia (n=41), and other reasons (n=26). Blood pressure data were collected at five time points: 0, 7, 14, 21, and 28 days after HSCT. Hypertension was defined as having systolic and/or diastolic blood pressure ≥95th percentile according to age, gender, and height. To analyze the risk factors related to hypertension, data, including patients' demographic and transplant characteristics, were reviewed. RESULTS: Hypertension developed in 59 patients (38%), among whom 12 (7.6%) required long term therapy. Thirty-two (54%) patients had systolic and diastolic, 8 (14%) had only systolic, and 19 (32%) had only diastolic hypertension. Younger age, acute graft-versus-host disease, sinusoidal obstruction syndrome, treatment with antifungal agent, and greater increase in serum creatinine (Cr) levels were associated with hypertension. Multivariate analysis showed that younger age at HSCT and greater increase in serum Cr level were independent risk factors for hypertension. CONCLUSION: Prevalence of hypertension during immediate post-HSCT period is high, especially in younger children. A greater increase in Cr after HSCT was significantly associated with hypertension. Further study is needed to elucidate long-term cardiovascular complications in pediatric HSCT survivors.

Incidence and Risk Factors for Early-Onset Hypertension after Allogeneic Hematopoietic Stem Cell Transplantation in Children

BACKGROUND AND OBJECTIVES: Survivors of pediatric hematopoietic stem cell transplantation (HSCT) are at risk for developing hypertension. The objectives of this study are to evaluate the prevalence and risk factors of early onset hypertension during the engraftment period after HSCT. SUBJECTS AND METHODS: This is a retrospective study of 157 consecutive patients (mean age at HSCT: 9.1+/-5.1 years) who underwent HSCT for acute myeloid leukemia (n=47), acute lymphoblastic leukemia (n=43), severe aplastic anemia (n=41), and other reasons (n=26). Blood pressure data were collected at five time points: 0, 7, 14, 21, and 28 days after HSCT. Hypertension was defined as having systolic and/or diastolic blood pressure > or =95th percentile according to age, gender, and height. To analyze the risk factors related to hypertension, data, including patients' demographic and transplant characteristics, were reviewed. RESULTS: Hypertension developed in 59 patients (38%), among whom 12 (7.6%) required long term therapy. Thirty-two (54%) patients had systolic and diastolic, 8 (14%) had only systolic, and 19 (32%) had only diastolic hypertension. Younger age, acute graft-versus-host disease, sinusoidal obstruction syndrome, treatment with antifungal agent, and greater increase in serum creatinine (Cr) levels were associated with hypertension. Multivariate analysis showed that younger age at HSCT and greater increase in serum Cr level were independent risk factors for hypertension. CONCLUSION: Prevalence of hypertension during immediate post-HSCT period is high, especially in younger children. A greater increase in Cr after HSCT was significantly associated with hypertension. Further study is needed to elucidate long-term cardiovascular complications in pediatric HSCT survivors.

The role of colonoscopy in diagnosis of gastrointestinal graft-versus-host disease and cytomegalovirus colitis after allergenic hematopoietic stem cell transplantation / 中华消化内镜杂志

0. 1). All the GI-GVHD and CMV colitis patients presented with a variety of colonic mucosal lesions. Besides the tortoiseshell-pattern mucosa and deep ulcer were characteristic lesions in GI-GVHD and CMV colitis respectively, the remaining mucosa lesions including edema, reddish patchy, erythma, erosion and superficial ulcer could not differentiate GI-GVHD from CMV colitis. Three GI-GVHD cases presented with pseud-omembrane, and 1 CMV colitis patient with herpes-like mucosa. Oozing bleeding of terminal-ileum mucosa and ileocecal valve inflammation could easily be found in GC patients. 63. 8% tissue samples were taken biopsies from rectosigmoid in GI-GVHD, and 70. 0% and 43. 8% in CMV colitis and GC patients respectively. Conclusion The positivity of peripheral blood CMV-DNA can not distinguish GI-GVHD from CMV colitis in allo-HSCT patients. GI-GVHD and CMV colitis manifest with a variety of lesions in colonoscopy, the tor- toiseshell-pattern mucosa in GI-GVHD and deep ulcer in CMV colitis are characteristic lesions. The patients of GI-GVHD complicated with CMV colitis readily present oozing bleeding of terminal-ileum mucosa and ileo-cecal valve inflammation. Colonoscopy and tissue biopsy of left-colon can diagnose the most of GI-GVHD and CMV colitis, but it's better to undertake pan-colon as well as terminal ileum examination for more accurate diagnosis.