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oai:recercat.cat:11351/133962025-10-24T10:29:39Zcom_2072_378070com_2072_378040col_2072_378092

Early cardiac events after haploidentical hematopoietic cell transplantation with post-transplant cyclophosphamide. subanalysis exploring cardiac toxicity conducted on behalf of GETH-TC R Pinto, Filipe Cascos Garcia, Enric Pérez-López, Estefanía Baile-González, Mónica Martín Rodríguez, Carlos Pascual, Maria Jesus Orti Pascual, Guillem Institut Català de la Salut [Pinto FR] Clinical Hematology Department, Unidade Local de Saúde de Santo António – Hospital de Santo António, Oporto, Portugal. [Cascos E] Cardiology Department, Institut Clínic Cardiovascular (ICCV), Hospital Clinic de Barcelona, Barcelona, Spain. [Pérez-López E, Baile-González M, Martín Rodríguez C] Hematology Department, Complejo Asistencial Universitario de Salamanca/Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain. [Pascual Cascón MJ] Hematology Department, Hospital Regional Universitario de Málaga, Málaga, Spain. [Ortí G] Grupo Español de Trasplante de Progenitores Hematopoyéticos y Terapia Celular, Madrid, Spain. Servei d’Hematologia, Vall d’Hebron Hospital Universitari, Barcelona, Spain Vall d'Hebron Barcelona Hospital Campus 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 Graft-versus-host disease prophylaxis; Cardiovascular toxicity; Early cardiac events Profilaxis de la enfermedad de injerto contra huésped; Toxicidad cardiovascular; Eventos cardíacos tempranos Profilaxi de la malaltia d'empelt contra hoste; Toxicitat cardiovascular; Esdeveniments cardíacs precoços Introduction: 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. 2025-07-11T06:56:36Z 2025-07-11T06:56:36Z 2025-05-01 info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion Pinto FR, Cascos E, Pérez-López E, Baile-González M, Martín Rodríguez C, Pascual Cascón MJ, et al. Early cardiac events after haploidentical hematopoietic cell transplantation with post-transplant cyclophosphamide. subanalysis exploring cardiac toxicity conducted on behalf of GETH-TC. Front Immunol. 2025 Maig 1;16:1571678. 1664-3224 http://hdl.handle.net/11351/13396 10.3389/fimmu.2025.1571678 40375982 001488342000001 http://hdl.handle.net/11351/13396 eng Frontiers in Immunology;16 https://doi.org/10.3389/fimmu.2025.1571678 Attribution 4.0 International http://creativecommons.org/licenses/by/4.0/ info:eu-repo/semantics/openAccess application/pdf Frontiers Media Scientia