Accelerated Aging after Hematopoietic Stem Cell Transplantation in Childhood

8 The first study showed that older age at HSCT and total body irradiation and busulfan-based conditionings were risk factors for early ovarian aging. Leukemia survivors with previous cranial radiotherapy or transplanted after disease relapse were at high risk of premature ovarian failure. The second study showed a higher frequency of carotid and femoral arterial plaques, thickened intima layer in radial and femoral arteries, increased carotid intima-media thickness and stiffness, decreased carotid compliance and arterial lumen diameters in brachial and femoral arteries and increased cardiovascular risk profile in the HR NBL survivors when compared to the controls. The third study showed that the HR NBL survivors had increased LV mass and decreased systolic and diastolic LV function when compared to the controls. Poor LV function associated with cardiac biomarkers, poor physical performance and increased BP. The fourth study showed shorter telomere length and increased frequency of frailty phenotype including decreased lean mass, slowness, weakness and low physical activity among the HR NBL survivors when compared to the age-matched controls. The frailty phenotype associated with cardiovascular health and chronic inflammation. In conclusion, our study shows that adult and adolescent survivors after HSCT at a young age are at risk of early reproductive and vascular aging and frailty. The survivors of pediatric HSCT require regular follow-up in adulthood and interventions for declining ovarian function, cardiovascular risk factors, high BP, subclinical signs of atherosclerosis and decreased cardiac function. Since lifestyle choices can influence cardiovascular health and frailty status, a healthy lifestyle, non-smoking and physical activity should be advocated among all survivors who have received HSCT in childhood.