Evaluation

• Obtain fasting lipid profile before transplantation

• Evaluate CHD risk

  1. If patient has CHD or CHD risk equivalent, then manage as high risk with appropriate therapy to reach LDL goal

     • Option to consider allogeneic HSCT patients 40 years of age or older as high risk

  2. Otherwise, calculate 10-year risk with online risk assessment tool (hp2010.nhlbihin.net/atpiii/calculator.asp?usertype=prof) and manage LDL per ATP-III guidelines

• Monitor lipid profiles after HSCT

  1. Check lipid profile within 4 weeks after HSCT and then at least every 3 months for patients on IST

  2. For patients at treatment goal on stable therapy every 6 to 12 months as indicated, or after significant change in IST regimen in patients with dyslipidemia

  3. If patients develop significant dyslipidemia after HSCT compared with baseline, consider secondary causes of dyslipidemia (IST, diabetes, and hypothyroidism)

  4. Even patients without dyslipidemia should have lipids monitored every 1 to 2 years after allogeneic HSCT given increased CV risk

Management

• If patient has high CHD risk (>20% 10-year risk), treat dyslipidemia with appropriate agent(s) to meet LDL goal, but monitor clinically if on IST or renal dysfunction

• In patients with low (<10%) or moderate CHD risk (10%–20%), consider drug treatment based upon severity of dyslipidemia, estimated prognosis after HSCT, and risks of lipid drug therapy (if on long-term IST for GVHD)

  1. In patients with low CHD risk that develop moderate secondary dyslipidemia on IST, this can be managed conservatively if IST will be tapered off

  2. Patients with low to moderate CHD risk that develop severe hypertriglyceridemia (> 500 mg/dL) should be treated to prevent pancreatitis

• Consider referral to a lipid specialist for the following:

  1. Severe dyslipidemia (total cholesterol > 300 or LDL > 180, triglycerides > 500-1000)

  2. Patients with dyslipidemia refractory to treatment and not meeting goals

  3. Patients with intolerance or contraindications to lipid-lowering therapy

  4. Patients requiring combination lipid therapy, particularly in the setting of IST

  5. Patients needing individualized cardiovascular risk assessment because of strong family history of premature CHD or other factors