期刊
JACC: CARDIOONCOLOGY
卷 3, 期 2, 页码 250-259出版社
ELSEVIER
DOI: 10.1016/j.jaccao.2021.02.011
关键词
allogeneic stem cell transplantation; cardiotoxicity; haploidentical transplantation; left ventricular systolic dysfunction; post-transplant cyclophosphamide
资金
- Association for Training, Education and Research in Hematology, Immunology, and Transplantation (ATERHIT)
This study compared clinical outcomes between patients who received post-transplant cydophosphamide (PT-Cy) and patients who did not, finding a higher incidence of early cardiac events in patients who received PT-Cy.
BACKGROUND Post-transplant cydophosphamide (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 tower 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. (C) 2021 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation.
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