Key result
Post-transplant cyclophosphamide is linked to ~2-fold higher early cardiotoxicity risk within 100 days.
Why the study?
Concerns remain regarding the cardiotoxicity of post-transplant cyclophosphamide (PT-Cy) used to prevent graft-versus-host disease after allogeneic hematopoietic stem cell transplantation.
Does post-transplant cyclophosphamide increase the risk of early cardiotoxicity in patients undergoing allogeneic hematopoietic stem cell transplantation?
Observational (n=1,381)
No
Does post-transplant cyclophosphamide increase the risk of early cardiotoxicity in patients undergoing allogeneic hematopoietic stem cell transplantation?
Hazard Ratio: 2 (95% CI 1.05–3.8)
p-value: p=0.035
The use of post-transplant cyclophosphamide is associated with a 2-fold increased risk of early cardiotoxicity within 100 days of allogeneic stem cell transplantation, highlighting the need for early cardiovascular risk assessment.
PT-Cy was associated with early cardiotoxicity; hypothesis-generating and requires prospective confirmation before practice change.
Introduction Although post-transplant cyclophosphamide (PT-Cy) is currently widely used to prevent graft-versus-host disease (GvHD) following allogeneic hematopoietic stem cell transplantation (alloHSCT), concerns remain regarding its cardiotoxicity. Purpose The aim was to investigate the association between early cardiotoxicity occurring within the first 100 days post-transplant and PT-Cy. Methods We conducted a monocentric retrospective observational study including all consecutive patients who underwent alloHSCT at our Hospital between July 2011 and July 2023. The primary endpoint was a composite of early cardiotoxicity, including cardiovascular death, heart failure (HF), myocarditis, pericardial disease, electrical disorders, and acute arterial events. A propensity-score matching was performed to balance characteristics between patients who received post-transplant PT-Cy and those who did not. Predictors of early cardiotoxicity were analyzed using Fine-and-Gray subdistribution hazard models. Results Among 1,381 patients, 143 (10%) experienced early cardiotoxicity within 100 days post-transplant. The most frequent events were HF (53%), electrical disorders (20%), and pericardial disease (19%). Age (sHR 1.01; 95% CI: 1.00-1.03; p=0.028), prior HF (sHR 2.02; 95% CI: 1.04-3.93; p=0.037), prior cancer therapy–related cardiac dysfunction (sHR 4.24; 95% CI: 2.05-8.78; p<0.001), hypertension (sHR 1.54; 95% CI: 1.00-2.36; p=0.047), and PT-Cy (sHR 1.62; 95% CI: 1.07-2.44; p=0.022) were independently associated with early cardiotoxicity. After 1:1 propensity score–matching, the administration of PT-Cy remained associated with cardiotoxicity (HR=2.00; 95% CI: 1.05-3.80; p=0.035). Conclusions The administration of PT-Cy was independently associated with an increased risk of early cardiotoxicity, particularly HF. These results underscore the need for early cardiovascular risk assessment and tailored surveillance, particularly in patients receiving PT-Cy.
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Gonçalves et al. (2026) conducted an observational in Allogeneic hematopoietic stem cell transplantation (n=1,381). Post-transplant cyclophosphamide vs. No post-transplant cyclophosphamide was evaluated on Composite of early cardiotoxicity (cardiovascular death, heart failure, myocarditis, pericardial disease, electrical disorders, and acute arterial events) (HR 2.00, 95% CI 1.05-3.80, p=0.035). Post-transplant cyclophosphamide administration was associated with an increased risk of early cardiotoxicity within 100 days post-transplant (HR 2.00; 95% CI 1.05-3.80; p=0.035).
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