Key result
Post-transplant cyclophosphamide linked to ~170% higher risk of early cardiac events after HSCT.
Why the study?
Post-transplant cyclophosphamide is standard in haploidentical HSCT to reduce graft-versus-host disease, but data on associated cardiac events are scarce.
Does post-transplant cyclophosphamide increase the risk of early cardiac events in patients undergoing allogeneic stem cell transplantation?
Cohort (n=331)
No
Does post-transplant cyclophosphamide increase the risk of early cardiac events in patients undergoing allogeneic stem cell transplantation?
Post-transplant cyclophosphamide is associated with a nearly 3-fold increased risk of early cardiac events within 100 days after hematopoietic stem cell transplantation, which negatively impacts overall survival.
Answers are grounded in this paper and cite their sources.
PT-Cy use in allogeneic HSCT warrants closer early cardiac surveillance; this Level 3 cohort finding leaves open causality and mitigation strategies.
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.
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Duléry et al. (2021) conducted a cohort in Hematologic malignant disease (n=331). Post-transplant cyclophosphamide vs. No post-transplant cyclophosphamide was evaluated on Early cardiac events within 100 days after transplantation (HR 2.7, 95% CI 1.4-4.9, p=0.002). Post-transplant cyclophosphamide was associated with a significantly higher incidence of early cardiac events within 100 days after hematopoietic stem cell transplantation compared to control (19% vs 6%, HR 2.7).
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