Cardio-Oncological Sequelae of Autologous Stem Cell Transplantation

Autologous hematopoietic stem cell transplantation is a major milestone in modern oncohematological therapies; however, both in the peritransplant and post-transplant phase, the incidence of cardiovascular (CV) events is markedly higher than in the general population. The pathomechanism of CV complications is multifactorial, determined by complex interactions between patient-specific, transplant-related, and oncological risk factors. In recent years, clonal hematopoiesis has emerged as a clinically relevant determinant of adverse CV outcomes. Patients undergoing autologous hematopoietic stem cell transplantation represent a high-risk CV population due to cumulative cytotoxic exposure, treatment-driven clonal selection, and increasing long-term survival. These factors highlight the need for future development of clonal hematopoiesis-based risk stratification models that combine gene-specific alterations, clonal expansion magnitude, and mutational burden with conventional CV risk factors. Novel risk stratification approaches may enable tailored patient follow-up, individualized preventive interventions, and the early detection and prevention of CV complications in this sensitive patient population.