Table 1 Etiology of dyslipidemia in patient after allo-HSCT

IR and diabetes [11, 13, 14]

In high glucose internal environment, LDL-C enzyme activity in adipose tissue decreases significantly, TGs metabolism slows down accordingly

VLDL, TGs, and TC↑

Immunosuppressants [16,17,18]

Glucocorticoids

① Reduce GLUT2 and glucokinase expression, stimulate B-cell apoptosis, enhance skeletal muscle insulin resistance, and reduce insulin uptake and glycogen storage. ② Enhance IR. ③ Lead to overproduction of triglycerides and VLDL-C. ④ The clearance of triglyceride rich lipoproteins such as chylomicron and VLDL-C is reduced by corticosteroid induced LPL.⑤enhances esterase activity and decreases LDL receptors.⑥lead to weight gain

VLDL, TGs, and TC↑

CNI

① Inhibit steroid 26 hydroxylase, thereby inhibiting cholesterol conversion into bile acid, blocking LDL receptors, leading to serum LDL elevation, and affecting VLDL and LDL clearance by changing lipase activity. ② Interfere with the binding of LDL-C to LDL receptors and promote hepatic lipase activity and the decrease of LPL.③inhibit insulin secretion of pancreatic B cells by binding to cyclin-D and inducing b cell apoptosis

VLDL and LDL↑

mTOR inhibitors

① Expand the FFA pool and increase hepatic VLDL synthesis. ② Increase lipolysis via augmentation of hormone-sensitive lipase (increasing circulating FFA), interfering with triglyceride metabolism, decreasing triglyceride storage, and disrupting the insulin-signaling pathway

VLDL, TGs↑

GVHD [1, 19, 20]

① Induce intrahepatic cholestasis and nephrotic syndrome. ② T cells in the process of GVHD depend on lipid biosynthetic pathways to meet the high metabolic requirement of rapid clonal expansion. ③ Disturbance of intestinal microbiota

TC, and TGs↑

Intestinal microflora

Gastrointestinal microflora can alter the enzymes that participate in the metabolism of three substances

Multiple metabolic disorders

Nutrition intake

Excessive high sugar and high fat nutrient intake

TC, and TGs↑

Others [21, 22]

Hypothyroidism, hyperthyroidism, hypogonadism, and growth hormone deficiency. Most of them are associated with conditioning such as TBI or cytotoxic agents

Multiple metabolic disorders