Incidence, Risk Factors, and Impact of Early Cardiac Toxicity after Allogeneic Hematopoietic Cell Transplantation.

This study investigates early cardiac events (ECE) occurring during the first 180 days after allo-HCT in 416 adults receiving PTCY (n=258) and non-receiving PTCY (n=158). Total body irradiation (TBI) was given to 133 (31.9%) patients, in 111 (83.4%) of them combined with PTCY. The day +180 cumulative incidence function (CIF) of ECE was 8.4%, being heart failure (n=13) and pericardial complications (n=11) as the most prevalent complications. The incidence of ECE was higher in patients receiving PTCY (Day +180 CIF: 11.3% vs. 3.8%, P=0.007), and receiving TBI (Day +180 CIF: 15.0% vs. 5.3%, P<0.001). ECEs were more prevalent in haplo-HCTs than in MSD, MUD, and MMUDs allo-HCTs (Day +180 CIF of 17.9%, 6.2%, 8.4% and 7.4%, P=0.005). As for the ECE's risks from the combination of PTCY and TBI, the multivariate analysis reported that patients receiving PTCY without TBI (HR 3.79, P=0.041), those receiving TBI without PTCY (HR 6.01, P=0.027), and patients receiving TBI and PTCY (HR 6.98, P=0.002) were at higher risk for ECE compared with patients receiving neither PTCY nor TBI. Pre-existing cardiac morbidity predicted ECE (HR 5.28, P<0.001). However, using high-dose Cy-containing preparative regimens did not increase the risk for cardiac toxicity at +180 days after allo-HCT (HR 0.58, P=0.53). ECE was associated with higher NRM (HR 4.68, P<0.001) and lower OS (HR 3.03, P<0.001). Considering that PTCY and TBI were predictors for ECE, and the impact of this complication on transplant mortality, the implementation of cardiac monitoring plans could be appropriate in patients receiving these medications.