Early Cardiac Toxicity Associated With Post-Transplant Cyclophosphamide in Allogeneic Stem Cell Transplantation.
JACC CardioOncol
; 3(2): 250-259, 2021 Jun.
Article
em En
| MEDLINE
| ID: mdl-34396331
ABSTRACT
BACKGROUND:
Post-transplant cyclophosphamide (PT-Cy) has become a standard of care in haploidentical hematopoietic stem cell transplantation (HSCT) to reduce the risk of graft-versus-host disease. However, data on cardiac events associated with PT-Cy are scarce.OBJECTIVES:
This study sought to assess the incidence and clinical features of cardiac events associated with PT-Cy.METHODS:
The study compared clinical outcomes between patients who received PT-Cy (n = 136) and patients who did not (n = 195), with a focus on early cardiac events (ECE) occurring within the first 100 days after HSCT. All patients had the same systematic cardiac monitoring.RESULTS:
The cumulative incidence of ECE was 19% in the PT-Cy group and 6% in the no-PT-Cy group (p < 0.001). The main ECE occurring after PT-Cy were left ventricular systolic dysfunction (13%), acute pulmonary edema (7%), pericarditis (4%), arrhythmia (3%), and acute coronary syndrome (2%). Cardiovascular risk factors were not associated with ECE. In multivariable analysis, the use of PT-Cy was associated with ECE (hazard ratio 2.7; 95% confidence interval 1.4 to 4.9; p = 0.002]. Older age, sequential conditioning regimen, and Cy exposure before HSCT were also associated with a higher incidence of ECE. Finally, a history of cardiac events before HSCT and ECE had a detrimental impact on overall survival.CONCLUSIONS:
PT-Cy is associated with a higher incidence of ECE occurring within the first 100 days after HSCT. Patients who have a cardiac event after HSCT have lower overall survival. These results may help to improve the selection of patients who are eligible to undergo HSCT with PT-Cy, especially older adult patients and patients with previous exposure to Cy.
CI, confidence interval; CVD, cardiovascular disease; CVRF, cardiovascular risk factor; Cy, cyclophosphamide; ECE, early cardiac events; GRFS, graft-versus-host disease-free, relapse-free survival; GVHD, graft-versus-host disease; HR, hazard ratio; HSCT, hematopoietic stem cell transplantation; LVEF, left ventricular ejection fraction; LVSD, left ventricular systolic dysfunction; PT-Cy, post-transplant cyclophosphamide; allogeneic stem cell transplantation; cardiotoxicity; haploidentical transplantation; left ventricular systolic dysfunction; post-transplant cyclophosphamide
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MEDLINE
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En
Ano de publicação:
2021
Tipo de documento:
Article