NEW research suggests that nonselective β-blockers may hinder bone marrow regeneration in patients undergoing haematopoietic cell transplants (HCT), particularly following post-transplant chemotherapy. Studies in mice revealed that treatment with nonselective β-blockers like carvedilol, but not with β1-selective inhibitors such as metoprolol, led to impaired haematopoietic regeneration after both syngeneic and allogeneic HCT.
In a clinical study conducted at two institutions, patients receiving carvedilol after allogeneic HCT exhibited delayed platelet engraftment and reduced survival rates, especially if they had also undergone chemotherapy to prevent graft-versus-host disease (GVHD). The inhibitory effect of carvedilol was most pronounced in these patients. In contrast, patients who received autologous HCT showed little to no delay in engraftment when given nonselective β-blockers.
The findings suggest that nonselective β-blockers may interfere with recovery after allogeneic HCT, particularly when used alongside post-transplant chemotherapy. However, increasing the number of transplanted haematopoietic cells could overcome these delays in mice. The study recommends that patients receiving allogeneic HCT might benefit from temporarily discontinuing nonselective β-blockers or switching to β1-selective blockers to accelerate engraftment and improve outcomes.
This discovery could prompt changes in clinical practices to enhance recovery and survival rates for patients undergoing allogeneic HCT, particularly those requiring chemotherapy for GVHD prevention.
Helena Bradbury, EMJ
Reference
Nishino J et al. Nonselective β-adrenergic receptor inhibitors impair hematopoietic regeneration in mice and humans after hematopoietic cell transplants. Cancer Discov. 2024; doi: 10.1158/2159-8290.CD-24-0719.
