Vascular changes after bone-marrow transplantation in children

  • Dr Maila Turanlahti, Hospital for Children and Adolescents, Department of Pediatric Cardiology, Helsinki, Finland, Finland
  • Dr Mervi Taskinen, Hospital for Children and Adolescents, Department of Hematology-Oncology and Stem Cell Transplantation, Helsinki, Finland, Finland
  • Dr Ulla Pihkala, Hospital for Children and Adolescents, Department of Hematology-Oncology and Stem Cell Transplantation, Helsinki, Finland, Finland
  • Dr Eero Jokinen, Hospital for Children and Adolescents, Department of Pediatric Cardiology, Helsinki, Finland, Finland

    • Objective.
    To study arterial stiffness and endothelial function in children after bone-marrow transplantation. Increased risk for metabolic syndrome has been observed as late effect of bone-marrow transplantation.
    Methods.
    Noninvasive vascular ultrasonic measurements were performed in 25 children 2.7 -11.6 years after bone-marrow transplantation, and in 22 controls (age range 6.4-15.5 years). Mechanical changes of the common carotid artery and flow-mediated dilatation of brachial artery were measured. Blood glucose, serum insulin and plasma lipid measurements were examined after an overnight fast.
    Results.
    The distensibility of carotid artery was significanty lower in the patients ( 0.48 ± 0.19 versus 0.64 ± 0.28 mmHg -1x10-2, p=0.024 ). The distensibility decreased with the time past BMT (p=0.009) but was dependent of the age only in the control group (p= 0.034) . The compliance of carotid artery was significantly decreased in the patients (0.10 ± 0.04 versus 0.13 ± 0.05, mm2xmmHg-1 , p= 0.041 ). The incremental elastic modulus (E inc) was higher in BMT patients (2.05 ± 0.7 versus 1.6 ± 0.6 mm Hgx103, p= 0.019) and was dependent of the time after BMT (p= 0.036).
    There was no difference in the flow-mediated dilatation between the two groups. Serum triglycerides were elevated in the patient group compared to controls (1.1 ±0.7 versus 0.7±0.3 mmol/l, p=0.026).
    Conclusions.
    Early mechanical changes of arterial wall were found after bone-marrow transplantation. The ultrasound measurements may offer a noninvasive method to find early alterations of the vascular bed and to optimize a preventive treatment of atherosclerosis.

    STUDY PATIENTS CONTROLS
    Number (F/M) 25 (12/13) 22 (12/10)
    Age, yrs (range) 11.0 (6.4-14.9) 11.3 (6.7-15.5)
    Weight, kg (range) 35.4 (18.5-70.0) 43.1 (22.3-71.8)
    Total cholesterol, mmol/l 4.5±0.8 4.4±0.7
    HDL cholesterol, mmol/l 1.6±0.4 1.7±0.3
    Triglycerides, mmol/l 1.1±0.7 0.7±0.3
    fB-Gluc, mmol/l 4.9±0.5 4.8±0.4
    fB-insulin, mmol/l 14.2±30.3 5.8±3.8