Early Cardiac Toxicity Associated With Post-Transplant Cyclophosphamide in Allogeneic Stem Cell Transplantation.
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|Rémy|R|', 'Mohty|Razan|R|', 'Labopin|Myriam|M|', 'Sestili|Simona|S|', 'Malard|Florent|F|', 'Brissot|Eolia|E|', 'Battipaglia|Giorgia|G|', 'Médiavilla|Clémence|C|', 'Banet|Anne|A|', 'Van de Wyngaert|Zoé|Z|', 'Paviglianiti|Annalisa|A|', 'Belhocine|Ramdane|R|', 'Isnard|Françoise|F|', 'Lapusan|Simona|S|', 'Adaeva|Rosa|R|', 'Vekhoff|Anne|A|', 'Ledraa|Tounes|T|', 'Legrand|Ollivier|O|', 'Cohen|Ariel|A|', 'Bonnin|Agnès|A|', 'Ederhy|Stéphane|S|', 'Mohty|Mohamad|M|']
post-transplant cyclophosphamide allogeneic stem cell transplantation left ventricular systolic dysfunction CI, confidence interval CVD, cardiovascular disease CVRF, cardiovascular risk factor Cy, cyclophosphamide ECE, early cardiac events GRFS, graft-versus-host disease-free, relapse-free survival GVHD, graft-versus-host disease HR, hazard ratio HSCT, hematopoietic stem cell transplantation LVEF, left ventricular ejection fraction LVSD, left ventricular systolic dysfunction PT-Cy, post-transplant cyclophosphamide cardiotoxicity haploidentical transplantation