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).
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.
Effect estimate: HR 2.7 (95% CI 1.4-4.9)
Absolute Event Rate: 19% vs 6%
p-value: p=0.002
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.
Duléry et al. (Tue,) 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).