Outcome of allogenic SCT in patients with low left ventricular ejection fraction

Abstract

7099 Background: High-dose therapy and allogeneic stem cell transplantation (allo SCT) is a potentially curative treatment for patients with hematologic malignancies. Due to a high risk of regimen-related toxicity, only patients with excellent organ-system function are considered eligible for this treatment. A low left ventricular ejection fraction (LVEF) of ≤ 45% is considered to be a major risk factor for post-transplant cardiac toxicity and nonrelapse mortality. However, several patients with advanced hematologic malignancies and low LVEF can potentially benefit from this therapy. To address this issue, we studied the incidence of cardiac toxicity and non-relapse mortality (NRM) in 56 patients with low LVEF undergoing allo SCT. Methods: We performed a retrospective analysis on 56 patients with impaired cardiac function, who underwent an allo SCT between January 2000 and February 2006 at our institution. Pre-transplant evaluation included bidimensional echocardiogram and an electrocardiogram. Cardiac toxicity was defined as congestive heart failure (CHF), atrial / ventricular arrhythmia or acute myocardial ischemia. Twenty-two patients received a myeloablative (16 busulfan-based, 6 TBI-based), while 34 patients received a fludarabine-based reduced-intensity preparative regimen. Results: Twenty-three patients (41%) received allo SCT from an unrelated donor. Acute leukemia was the reason for allo SCT in 32 (57%) patients. Baseline LVEF, within 30 days prior to allo SCT, ranged from 20 to 45%. After a minimum of 6-month follow up, cardiac toxicity was seen in 7 (12%) patients. That included CHF in 4 (7%) and atrial fibrillation (AF) in 4 (7%). One patient had both CHF and AF. There were no documented episodes of acute myocardial ischemia. Cumulative incidence of NRM at 100 days was 12%, none of the deaths being attributable to a cardiac cause. These were comparable to allo SCT performed in patients with normal LVEF. Age, degree of left vetricular dysfunction, type of transplant or the underlying disease did not emerge as significant predictors of post-transplant cardiac toxicity or NRM. Conclusions: Allogeneic SCT is feasible in patients with hematologic malignancies and low LVEF. A prospective study with stratification for cardiac risk factors is warranted in patients with low LVEF. No significant financial relationships to disclose.