Risk factors for fatal cardiac complications after allogeneic hematopoietic cell transplantation: Japanese Society for Transplantation and Cellular Therapy transplant complications working group

Abstract

Fatal cardiac complications can occur from the early to late phases after hematopoietic cell transplantation (HCT). Herein, the Japanese transplant registry database was used to retrospectively analyze health records of 33,791 allogeneic HCT recipients to elucidate the pathogenesis and risk factors involved. Overall, 527 patients died of cardiac complications at a median of 130 (range 0–3924) days after HCT. The cumulative incidence of fatal cardiac complications was 1.2% (95% confidence interval [CI]: 1.0–1.3) and 1.6% (95% CI: 1.5–1.8) at 1 and 5 years after HCT, respectively. Fatal cardiovascular events were significantly associated with an HCT‐specific comorbidity index (HCT‐CI) score of ≥1 specific to the three cardiovascular items, lower performance status, conditioning regimen cyclophosphamide dose of >120 mg/kg, and female sex. Cardiovascular death risk within 60 days after HCT was associated with the type of conditioning regimen, presence of bacterial or fungal infections at HCT, and number of blood transfusions. Contrastingly, late cardiovascular death beyond 1 year after HCT was associated with female sex and older age. Lower performance status and positive cardiovascular disease‐related HCT‐CI were risk factors for cardiac complications in all phases after HCT. Systematic follow‐up may be necessary according to the patients' risk factors and conditions.

Cardiac Events Occurring after Allogeneic Hematopoietic Cell Transplantation with Post-Transplant Cyclophosphamide. Study Conducted on Behalf of the GETH-TC

“…The diagnoses of HTN and of DLP were identi ed as risk factors for CE after allo-HCT. In contrast, older age, pre-existing cardiac disease, and Cy or TBI administration as part of the myeloablative preparative regimens were not predictors for CE in our analysis (28,29,34). The facts that, among the participant institutions, the majority of patients with cardiac morbidity underwent assessment and clearance by Cardiology departments before transplantation, and that older adults received more exhaustive monitoring during the HCT process due to their assumed higher risk for CVR-CVT, could had mitigated the potential risk for cardiac toxicity among these patients.…”