Arrhythmias in hematopoietic stem cell transplantation: A systematic review and meta‐analysis

Chiengthong, Kanhatai; Lertjitbanjong, Ploypin; Sharma, Konika; Prasitlumkum, Narut; Mao, Michael A; Cheungpasitporn, Wisit; Chokesuwattanaskul, Ronpichai

doi:10.1111/ejh.13322

Cited by 14 publications

(9 citation statements)

References 42 publications

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“…To date, studies examining AF after HCT have been limited to patients undergoing autologous HCT, [32][33][34][35][36][37][38] representing an older population with greater comorbidities and a higher proportion of pre-HCT cardiotoxic (eg, chest radiation and anthracyclines) exposures, compared with patients undergoing allogeneic HCT. To our knowledge, our study is the first to describe the incidence and risk factors for AF in a contemporary cohort of allogeneic patients, allowing us to capture evolving HCT practices (eg, expanding donor stemcell source, use of nonmyeloablative conditioning, increasingly older age at HCT, and expanded indications for HCT).…”

Section: Discussionmentioning

confidence: 99%

Atrial Fibrillation in Patients Undergoing Allogeneic Hematopoietic Cell Transplantation

Chang

Chanson

Teh

et al. 2021

JCO

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PURPOSE To examine the incidence and risk factors for de novo atrial fibrillation (AF) after allogeneic hematopoietic cell transplantation (HCT) and to describe the impact of AF on HCT-related outcomes. METHODS A retrospective cohort study design was used to examine AF and associated outcomes in 487 patients who underwent allogeneic HCT from 2014 to 2016 and to characterize patient- and HCT-related risk factors. A nested case-control study design was used to describe the association between pre-HCT echocardiographic measures and future AF events. RESULTS The median age at HCT was 52.4 years (18.1-78.6); the median time to AF was 117.5 days (4.0-1,405.0). The 5-year cumulative incidence of AF was 10.6%. Older (≥ 50 years) age (hazard ratio [HR], 2.76; 95% CI, 1.37 to 5.58), HLA-unrelated donor (HR, 2.20; 95% CI, 1.18 to 4.12), dyslipidemia (HR, 2.40; 95% CI, 1.23 to 4.68), and pre-HCT prolonged QTc interval (HR, 2.55; 95% CI, 1.38 to 4.72) were independent risk factors for AF. Despite having comparable left ventricular systolic function, patients who developed AF were significantly more likely to have lower left atrial ejection fraction, left atrial reservoir function, and elevated tricuspid regurgitant jet velocity prior to HCT, compared with patients who did not. The incidence rate of stroke after AF was 143 per 1,000 person-years. In adjusted analyses, AF was associated with a 12.8-fold (HR, 12.76; 95% CI, 8.76 to 18.57) risk of all-cause mortality and 15.8-fold (HR, 15.78; 95% CI, 8.70 to 28.62) risk of nonrelapse mortality. CONCLUSION The burden of AF after allogeneic HCT population is substantial, and the development of AF is associated with poor survival. We identified important associations between patient demographics, pre-HCT cardiac parameters, HCT-related exposures, and risk of AF, setting the stage for targeted prevention strategies during and after HCT.

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Section: Discussionmentioning

confidence: 99%

Atrial Fibrillation in Patients Undergoing Allogeneic Hematopoietic Cell Transplantation

Chang

Chanson

Teh

et al. 2021

JCO

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“…[ 21 ] A recent meta-analysis revealed that the estimated incidence of all types of arrhythmia following HCT was 7.20% (95% CI: 4.90–10.50), and the most common type was AF/AFL, with an estimated incidence of 4.20% (95% CI: 1.70–9.60). [ 22 ] In our study, the most common post-CCVD were also HF and arrhythmia (6.02% and 5.26%, respectively). Late post-CCVD was reported to be associated with chemotherapy toxicity, CVRFs, chronic graft- vs .-host disease, and long-term physical inactivity.…”

Section: Discussionmentioning

confidence: 51%

“…The incidence of early fatal cardiotoxicity during the first 100 days post-transplant was reported to be 0.90% to 10.00%, of which the most common events were HF and arrhythmia [21] . A recent meta-analysis revealed that the estimated incidence of all types of arrhythmia following HCT was 7.20% (95% CI: 4.90–10.50), and the most common type was AF/AFL, with an estimated incidence of 4.20% (95% CI: 1.70–9.60) [22] . In our study, the most common post-CCVD were also HF and arrhythmia (6.02% and 5.26%, respectively).…”

Section: Discussionmentioning

confidence: 99%

“…There was no difference in the median days of neutrophil (14 [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24] vs. 12 [9-21] days, P = 0.269) and platelet (14 vs. 14 days, P = 0.395) engraftment between the pre-CCVD group and the control group. In the multivariable analysis, rapid neutrophil recovery was associated with a greater number of infused CD34 + cells (P = 0.016) and disease status in remission (P = 0.002).…”

Section: Outcomes Of Transplantationmentioning

confidence: 99%

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Increased risk of cardio-cerebrovascular disease after hematopoietic cell transplantation in patients with previous history

Peng

Wang

Dou

et al. 2021

Chinese Medical Journal

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Background: The impacts of previous cardio-cerebrovascular disease (pre-CCVD) on the outcomes of hematopoietic cell transplantation (HCT) are not well described. Patients with pre-CCVD may often be poor candidates for HCT. This study aimed to investigate the impact of pre-CCVD on transplant outcomes. Methods: A retrospective study was conducted between patients with and without pre-CCVD who consecutively received allogeneic or autologous HCT between November 2013 and January 2020 with a matching of age and disease status. The cardiovascular complications and HCT outcomes of the two groups were evaluated and compared. The primary endpoints were post-transplant cardio-cerebrovascular disease (post-CCVD) and non-relapse mortality (NRM). We used a multivariable Cox proportional hazard model and the Fine-Gray competing risk regressions for analyses to estimate the hazard ratios (HRs). Results: The outcomes of 23 HCT recipients with pre-CCVD were compared with those of 107 patients in the control group. No significant differences were noted in terms of engraftment, overall survival (OS) (67.00% vs. 67.90%, P = 0.983), or relapse (29.78% vs. 28.26%, P = 0.561) between the pre-CCVD group and the control group. The cumulative incidences of 2-year NRM were similar between patients with pre-CCVD and the controls (14.68% vs. 17.08%, P = 0.670). However, pre-CCVD was associated with an increased incidence of post-CCVD (HR: 12.50, 95% confidence interval [CI]: 3.88–40.30, P < 0.001), which was an independent risk factor for increased NRM (HR: 10.29, 95% CI: 3.84–27.62, P < 0.001) and inferior OS (HR: 10.29, 95% CI: 3.84–27.62, P < 0.001). Conclusions: These findings suggest that the existence of pre-CCVD before transplantation might not result in increased mortality directly but superpose the toxicity of the transplantation procedure, leading to a risk of post-CCVD. Post-CCVD was a powerful predictor for high NRM and inferior OS. Further risk stratification of pre-CCVD is needed to reduce NRM in various transplantation settings.

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“…Cardiovascular complications have been reported in this setting primarily as a result of cytokine release syndrome and complications [ 64 ]. The most common malignancy treated with autologous stem cell transplantation is multiple myeloma [ 65 ], which associates with cardiomyopathy and poor outcomes [ 55 , 66 – 69 ].…”

Section: Cardiotoxicities In Cardio-oncologymentioning

confidence: 99%

Artificial intelligence opportunities in cardio-oncology: Overview with spotlight on electrocardiography

Lara-Martinez

Noseworthy

Akbilgiç

et al. 2022

American Heart Journal Plus: Cardiology Research and Practice

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Arrhythmias in hematopoietic stem cell transplantation: A systematic review and meta‐analysis

Cited by 14 publications

References 42 publications

Atrial Fibrillation in Patients Undergoing Allogeneic Hematopoietic Cell Transplantation

Atrial Fibrillation in Patients Undergoing Allogeneic Hematopoietic Cell Transplantation

Increased risk of cardio-cerebrovascular disease after hematopoietic cell transplantation in patients with previous history

Artificial intelligence opportunities in cardio-oncology: Overview with spotlight on electrocardiography

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