After AHSCT, early and late MACE risk was similar in males and females, but sex-specific predictors suggest tailored risk stratification is needed.
Are there sex differences in the incidence of major adverse cardiovascular events (MACE) among patients undergoing allogeneic hematopoietic stem cell transplantation?
Following allogeneic hematopoietic stem cell transplantation, males and females have a similar incidence of early and late MACE, though the independent predictors of these events differ by sex.
Absolute Event Rate: 0% vs 0%
Abstract Background Allogeneic hematopoietic stem cell transplantation (AHSCT) represents a major therapeutic challenge in the treatment of hematologic malignancies. However, the conditioning regimens, including chemotherapy and radiotherapy, are associated with both short- and long-term cardiotoxicity, increasing the risk of major adverse cardiovascular events (MACE). While sex-based differences in cardiovascular disease (CVD) have been extensively documented in the general population, their impact on AHSCT outcomes and the development of subsequent CVD remains poorly known. Purpose To investigate sex differences in AHSCT outcomes and identify independent predictors of MACE by sex in a large cohort of AHSCT patients. Methods Between 2011 and 2020, we conducted a retrospective, single-centre longitudinal cohort study including all consecutive patients with hematologic malignancies undergoing AHSCT. The primary composite outcome was MACE, including cardiovascular death, incident heart failure (HF), rhythm/conduction disorders, acute arterial events, venous thromboembolism (VTE), and myopericarditis. A propensity score matching was performed to balance characteristics between males and females. Predictors of MACE were analysed using Cox proportional hazards regression. Results In the propensity-score matched population (N=786 patients, 50% males and 50% females, mean age 44±16 years), 30% patients experienced MACE after a median (IQR) follow-up of 4 (1-7) years. The cumulative incidence of early MACE (≤100 days) was similar between males and females (12.6% versus 13.8%, p=0.67), with the primary causes being HF and supraventricular arrhythmia in males, and HF and pericardial disease in females. At 4 years, the cumulative incidence of late MACE remained comparable between males and females (17.3% vs. 18.1%, p=0.91), with HF, VTE, and pericardial disease as the predominant causes. Among males, the following variables were identified as predictors of early MACE: history of hypertension (HR: 2.16; 95% CI: 1.07–4.33; p=0.031), smoking status (HR: 1.90; 95% CI: 1.08–3.35; p=0.026), history of supraventricular arrhythmia (HR: 3.43; 95% CI: 1.07–11.0; p=0.039), history of cancer-therapy related cardiac dysfunction (HR: 5.51; 95% CI: 2.18–13.9; p0.001), previous use of liposomal anthracyclines (HR: 2.83; 95% CI: 1.02–7.89; p=0.046), age (HR: 1.02; 95% CI: 1.00–1.04; p=0.022), and haploidentical donor transplant (HR: 3.18; 95% CI: 1.40–7.22; p=0.006). In males, predictors of early MACE included history of hypertension (HR: 2.34; 95% CI: 1.23–4.45; p=0.009), history of HF (HR: 3.70; 95% CI: 1.34–10.3; p=0.012), and left ventricular ejection fraction (HR: 0.96; 95% CI: 0.92–1.00; p=0.039). Conclusion After propensity score matching, the risk of early and late MACE was similar between males and females following AHSCT. However, sex-specific differences in predictors may suggest the need for sex-specific risk stratification prior to AHSCT. Study population
Goncalves et al. (Sat,) reported a other. After AHSCT, early and late MACE risk was similar in males and females, but sex-specific predictors suggest tailored risk stratification is needed.