Early onset AF incidence within 90 days post-HCT was 4.5% in alloHCT vs 0.7% in autoHCT; age≥50 tripled risk (HR=2.9 allo, HR=2.4 auto), plus low KFS and obesity increased risk.
Does allogeneic HCT compared to autologous HCT increase the incidence of early-onset atrial fibrillation in patients without prior AF?
Early-onset atrial fibrillation within 90 days after hematopoietic cell transplant is more common following allogeneic compared to autologous transplant, with older age and lower performance status as key risk factors.
Absolute Event Rate: 0% vs 0%
Abstract Background/Introduction Atrial fibrillation (AF) is one of the most common acute cardiovascular complications following hematopoietic cell transplant (HCT). However, little is known about the incidence and risk factors for early-onset AF post-HCT. Purpose To assess the incidence and risk factors for the onset of AF within 90 days after HCT. Methods A retrospective cohort study design was used to assess the onset of AF within 90 days after HCT and its risk factors in 5965 patients without a history of AF who underwent allogeneic HCT (alloHCT, n=2742) or autologous HCT (autoHCT, n=3223) at City of Hope (COH), Duarte, CA, USA, between 2010.01ꟷ2023.12. Patients’ data were collected with IRB approval through the COH Research Informatics and medical chart review. Cumulative incidence of AF (AFCI) within 90 days after HCT was calculated with consideration of the competing risk of death for right-censored data. Fine-Gary proportional subdistributional hazard models were used to estimate hazard ratios (HRs) and 95% confidence intervals (95% CIs) for associations between factors of interest and AF risk in alloHCT and autoHCT patients separately. The factors of interest included demographics (age, gender, race), medical history (comorbidity index, diabetes, hepatic diseases, pulmonary diseases, psychiatric disturbance, obesity), primary diagnosis, karnofsky performance score (KFS), and conditioning regimen. Additionally, for alloHCT patients, we considered donor-receipt gender match, donor type ABO blood group compatibility, and sirolimus used for GVHD prophylaxis. All statistical tests were 2-sided at a significance level of 0.05. All statistical analyses were performed using SAS 9.4 (SAS Institute, Cary, NC). Results The median age was 54 years (range18-82) for alloHCT and 59 years (range 18-78) for autoHCT patients. Most patients were male (alloHCT 54%, autoHCT 56%) and white (alloHCT 76%, autoHCT 70%). The most common primary diagnosis was acute myeloid leukemia (41%) in alloHCT patients and multiple myeloma (59%) in autoHCT patients. AFCI within 90 days after HCT was higher in alloHCT than autoHCT patient (4.5% vs. 0.7%, Gray test p0.001). Multivariable analyses showed that older age (≥50 vs. 50 years, HR=2.9, 95%=1.9-4.3), lower KFS (80 vs. ≥80, HR=1.7, 95% CI=1.1-2.7), and matched unrelated donor (vs. matched related donor, HR=1.4, 95% CI=1.0-2.0) were associated with increased risk of AF in alloHCT patients. Older age (HR=2.4, 95% CI=1.4-4.0), lower KFS (HR=2.4, 95% CI=1.5-3.8) and obesity (HR=1.6, 95% CI=1.0-2.4) were associated with increased risk of AF in autoHCT patients. Conclusion(s) The analysis of a large cohort of HCT patients indicates AFCI in 90 days after HCT to be higher in alloHCT than autoHCT patients. Patients with older age, lower KFS, obesity, or matched unrelated donor (limited to alloHCT) had an increased risk for early onset AF after HCT.
Cai et al. (Sat,) reported a other. Early onset AF incidence within 90 days post-HCT was 4.5% in alloHCT vs 0.7% in autoHCT; age≥50 tripled risk (HR=2.9 allo, HR=2.4 auto), plus low KFS and obesity increased risk.