Key result
In patients with systemic amyloidosis undergoing autologous HSCT, pretransplant LVEF <60% was strongly associated with the development of cardiac dysfunction (OR 17.78; 95% CI 2.29-138.33; P=0.006).
Why the study?
What pretransplant factors predict cardiac dysfunction following high-dose melphalan conditioning and autologous HSCT in patients with multiple myeloma and systemic amyloidosis?
Case-Control (n=1,476)
What pretransplant factors predict cardiac dysfunction following high-dose melphalan conditioning and autologous HSCT in patients with multiple myeloma and systemic amyloidosis?
Odds Ratio: 17.78 (95% CI 2.29–138.33)
p-value: p=0.006
Pretransplant LVEF <60%, lower HDM dose, and multi-organ amyloid involvement are significant predictors of cardiac dysfunction following autologous stem cell transplantation in patients with systemic amyloidosis.
Pretransplant LVEF assessment may guide closer cardiac monitoring in amyloidosis HSCT patients; leaves open prospective validation of risk thresholds.
BACKGROUND: Cardiac complications following hematopoietic stem cell transplantation (HSCT) are emerging as a significant concern given the increasing utilization of HSCT for a variety of hematologic malignancies. METHODS: We utilized an existing database to determine the frequency of cardiac dysfunction (CD), namely a decrease in left ventricular ejection fraction, following conditioning with high-dose melphalan (HDM) and autologous HSCT for multiple myeloma (MM) and systemic amyloidosis (AL). We then performed a case-control study to examine variables associated with increased risk of CD in this population. RESULTS: In MM patients undergoing HSCT, the rate of CD was 1.6% (17/1050, 95% CI: [0.9, 2.6]). None of the examined pre-HSCT variables or HDM dose were significantly associated with development of CD in this population. In patients with AL, the rate of CD was 5.6% (24/426, 95% CI: [3.6, 8.3]). On univariate analysis, decision to administer an HDM dose <200 mg/m(2) [odds ratio (OR): 4.59 (1.27-16.57) P = 0.02], pretransplant left ventricular ejection fraction <60% [OR: 17.78 (2.29-138.33) P = 0.006], and documented amyloid involvement of ≥ 3 organs [OR: 4.0 (1.03-15.6) P = 0.046] were associated with the development of CD in the AL population. No other examined peri-transplant factors were associated with development of CD. CONCLUSION: To our knowledge, this is the first series to report a significant rate of CD following HDM conditioning and autologous HSCT in patients with AL.
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Bleeker et al. (2012) conducted a case-control in Multiple myeloma and systemic amyloidosis (n=1,476). Pretransplant LVEF <60% vs. Pretransplant LVEF ≥60% was evaluated on Cardiac dysfunction (decrease in left ventricular ejection fraction) (OR 17.78, 95% CI 2.29-138.33, p=0.006). In patients with systemic amyloidosis undergoing autologous HSCT, pretransplant LVEF <60% was strongly associated with the development of cardiac dysfunction (OR 17.78; 95% CI 2.29-138.33; P=0.006).
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