The short-term Cardiotoxicity after Allogeneic Hematopoietic Stem Cell Transplantation: A Retrospective single center experience

Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is considered the best cure for many hematologic diseases, but it is associated with multiple short and long term cardiovascular adverse effects. This retrospective study assesses the short-term cardiovascular consequences after allo-HSCT and compares the risk of developing cardiotoxicity based on conditioning regimens and post-transplant prophylactic medications. A total of 310 patients were identified at the American University of Beirut Medical Center (AUBMC), of whom 255 were followed up for 100 days post-transplant. There was a significant decrease in left ventricular ejection fraction (LVEF), from a mean of 59.14% pre-transplant to 58.44% post-transplant (P= 0.037). Significant decreases were also noted in the E wave, E' wave, and E/A ratio (P <0.01, <0.001, and 0.006, respectively), while no significant changes were observed in A wave or E/E' ratio (P= 0.197 and 0.078, respectively). No significant decrease in global longitudinal strain was noted (P=0.18). Haploidentical transplants, cyclophosphamide, and sequential conditioning regimens were associated with reduced LVEF (P= 0.002, 0.007 and 0.019, respectively). Among those followed up for 100 days, 8 patients (3.2%) developed moderate or large pericardial effusion. While the average decrease in LVEF was of no clinical significance, the percentage of patients with reduced LVEF (<50%) increased from 3.1% pre-transplant to 6.7% at 100 days. These subclinical changes in LVEF and diastolic measurements are not fully understood. We recommend serial echocardiographic follow-ups to assess their potential clinical relevance and the risk of cardiotoxicity later in life, particularly those undergoing haploidentical transplant, receiving cyclophosphamide or sequential conditioning regimens.