Severe (grade ≥3) cardiac adverse events occurred in 8.12% of patients by day 100 after HSCT with post-transplant cyclophosphamide, and were associated with worse 1-year overall survival (36.4% vs 71.1%, P=0.0001).
Cohort (n=286)
No
Severe cardiac toxicity after HSCT with post-transplant cyclophosphamide is uncommon but associated with significantly reduced 1-year overall survival, highlighting the need for risk stratification in patients with baseline cardiac risk factors.
selected donor stem cells (Step 2). We examined cardiac AEs in recipients of HSCT with PT-Cy across 7 prospective clinical trials conducted at Thomas Jefferson University Hospital from 2012 to 2023. Adverse events were graded per Common Terminology Criteria for Adverse Events (CTCAE) version 5.0. Results: Two hundred eighty-six patients were included in the study. Most patients received haploidentical (HI) HSCT (n = 197, 69%), 24 (8.4%) had matched related donors (MRD), and 60 (21%) had matched unrelated donors (MUD). Patients received myeloablative (n = 131, 46%), reduced intensity (n = 121, 25%), or nonmyeloablative (n = 34, 12%) conditioning regimens. Approximately half of the patients (n = 146, 51%) experienced grade 1-4 cardiac AEs from time of receiving donor cells to day 100. Twenty-two patients experienced grade ≥3 cardiac events, with a cumulative incidence of 7.38% at 50 d and 8.12% at 100 d. Twenty-three Grade ≥3 cardiac AEs were recorded. The vast majority of grade ≥3 cardiac AEs occurred through day 30 (n = 20, 87%) and 13% (n = 3) from Day 30 to Day 100. The most common grade ≥3 cardiac AE was heart failure (n = 10, 43%), followed by arrhythmia (n = 6, 26%), pericardial effusion (n = 5, 22%), chest pain (n = 1, 4%) and cardiac arrest (n = 1, 4%). The 1-year OS was 71.1% for patients without G ≥3 cardiac event vs 36.4% for patients with G ≥3 AEs (P = .0001). The presence of having any cardiac risk factors (arrhythmia, CAD, CHF, and other) increase risks of having G3 or more cardiac toxicity (OR = 2.65, P = .0375). Cardiac toxicity is common after HSCT with PT-Cy, however severe cardiac AEs are uncommon, and mortality is rare. Most cardiac AEs occurred in the first 30 d post donor cells infusion. Heart failure, arrhythmias and pericardial effusion constituted most severe cardiac AEs. Patients who experienced grade ≥3 cardiac events had worse OS than patients that did not.
Gradone et al. (Tue,) conducted a cohort in Allogenic stem cell transplant (n=286). Allogenic stem cell transplant with post-transplant cyclophosphamide was evaluated on Grade ≥3 cardiac adverse events at 100 days. Severe (grade ≥3) cardiac adverse events occurred in 8.12% of patients by day 100 after HSCT with post-transplant cyclophosphamide, and were associated with worse 1-year overall survival (36.4% vs 71.1%, P=0.0001).