2026-04-17T16:19:03Zhttps://recercat.cat/oai/requestoai:recercat.cat:11351/133962025-10-24T10:29:39Zcom_2072_378070com_2072_378040col_2072_378092
RECERCAT
author
R Pinto, Filipe
author
Cascos Garcia, Enric
author
Pérez-López, Estefanía
author
Baile-González, Mónica
author
Martín Rodríguez, Carlos
author
Pascual, Maria Jesus
author
Orti Pascual, Guillem
2025-10-24T10:29:39Z
2025-10-24T10:29:39Z
2025-07-11T06:56:36Z2025-07-11T06:56:36Z2025-05-01
http://hdl.handle.net/11351/13396
Graft-versus-host disease prophylaxis; Cardiovascular toxicity; Early cardiac eventsProfilaxis de la enfermedad de injerto contra huésped; Toxicidad cardiovascular; Eventos cardíacos tempranosProfilaxi de la malaltia d'empelt contra hoste; Toxicitat cardiovascular; Esdeveniments cardíacs precoçosIntroduction: Haploidentical allogeneic hematopoietic cell transplantation (haplo-HCT) using post-transplant cyclophosphamide (PTCY) has become a standard approach for patients lacking HLA-matched donors. While effective in reducing graft-versus-host disease (GVHD), concerns about PTCY-associated cardiovascular toxicity remain. This study investigates the incidence, predictors, and impact of early cardiac events (ECE) in haplo-HCT recipients.
Methods: We conducted a retrospective, multicenter analysis of 268 patients with acute myeloid leukemia (AML) treated with anthracycline-based induction regimens and undergoing their first haplo-HCT with PTCY (50 mg/kg/day on days +3 and +4) between 2011 and 2022. ECEs, defined as any new cardiac event within 100 days post-transplant, were analyzed using cumulative incidence functions considering death and relapse as competing risks. Risk factors and the impact on non-relapse mortality (NRM) and overall survival (OS) were assessed via univariate and multivariate regression models.
Results: The median patient age was 57 years (range: 18–79), and pre-transplant comorbidities included hypertension (22.4%), dyslipidemia (13.1%), diabetes mellitus (6.7%), and prior cardiac history (14.2%). ECEs occurred in 23 patients (8.6%) at a median of 19 days post-transplant (IQR: 5–66), with a day +100 cumulative incidence of 8.6% (95% CI: 6.1–12.3). The most frequent complications were pericardial effusion/pericarditis (43.5%), arrhythmias (30.4%), and heart failure (17.4%). Severe ECEs (CTCAE grade 3–4) were observed in 30.4% of cases, and four deaths (17.4%) were directly attributed to ECEs. Univariate analysis identified dyslipidemia (HR: 3.87, p=0.001), hypertension (HR: 2.76, p=0.015), and moderate-severe veno-occlusive disease (HR: 4.94, p=0.002) as significant predictors of ECE. ECEs were associated with lower OS (HR: 1.78, p=0.04) and higher NRM (HR: 2.87, p=0.005).
Discussion: While the incidence of ECEs following haplo-HCT with PTCY was relatively low, their occurrence significantly worsened transplant outcomes. These findings underscore the importance of cardiovascular risk assessment and structured cardiac monitoring to mitigate complications in haplo-HCT recipients.
Attribution 4.0 International http://creativecommons.org/licenses/by/4.0/ info:eu-repo/semantics/openAccess
Empelt contra l'hoste, Malaltia de l'
Cor - Malalties
Cèl·lules mare hematopoètiques - Trasplantació
Trasplantació d'òrgans, teixits, etc.
DISEASES::Cardiovascular Diseases
DISEASES::Pathological Conditions, Signs and Symptoms::Pathologic Processes::Cardiotoxicity
DISEASES::Immune System Diseases::Graft vs Host Disease
ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT::Therapeutics::Biological Therapy::Cell- and Tissue-Based Therapy::Cell Transplantation::Stem Cell Transplantation::Hematopoietic Stem Cell Transplantation
Other subheadings::Other subheadings::Other subheadings::/adverse effects
ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT::Surgical Procedures, Operative::Transplantation::Transplantation, Homologous::Transplantation, Haploidentical
ENFERMEDADES::enfermedades cardiovasculares
ENFERMEDADES::afecciones patológicas, signos y síntomas::procesos patológicos::cardiotoxicidad
ENFERMEDADES::enfermedades del sistema inmune::enfermedad injerto contra huésped
TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS::terapéutica::terapia biológica::tratamientos basados en células y tejidos::trasplante de células::trasplante de células madre::trasplante de células madre hematopoyéticas
Otros calificadores::Otros calificadores::Otros calificadores::/efectos adversos
TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS::intervenciones quirúrgicas::trasplante::trasplante homólogo::trasplante haploidéntico
Early cardiac events after haploidentical hematopoietic cell transplantation with post-transplant cyclophosphamide. subanalysis exploring cardiac toxicity conducted on behalf of GETH-TC
info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion