Safety of Post-Transplant Cyclophosphamide-Based Prophylaxis in AML Patients with Pre-Existing Cardiac Morbidity Undergoing Allogeneic Hematopoietic Cell Transplantation

Background: Post-transplant cyclophosphamide (PTCy) is a standard graft-versus-host disease (GVHD) prophylaxis in allogeneic hematopoietic cell transplantation (allo-HCT). While effective, concerns remain about cyclophosphamide-related cardiotoxicity, especially in patients with pre-existing cardiac...

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Detalhes bibliográficos
Autores: Torrent-Rodríguez, Arnau, Cascos, Enric, Garcés, Víctor Navarro, Pérez-López, Estefanía, Baile-González, Mónica, Rodríguez, Carlos Martín, Cascón, María Jesús Pascual, Luque, Marta, Esquirol, Albert, Calvo, Carmen Martín, Peña-Muñoz, Felipe, Fernando, Inmaculada Heras, Ormtegi, Itziar Oiartzabal, Marín, Adolfo Jesús Sáez, Fernández-Luis, Sara, Domínguez-García, Juan José, Fernández, Sara Villar, Lorenzo, José Luis López, de Sanmamed Girón, Miguel Fernández, Pinedo, Leslie González, Garcia-Maño, Lucia, González-Rodriguez, Ana Pilar, Torrado, Tamara, Filaferro, Silvia, Basalobre, Pascual, Ortí, Guillermo, Rovira, Montserrat, Chacón, Manuel Jurado, Salas, María Queralt
Formato: artículo
Fecha de publicación:2025
País:España
Recursos:Conselleria de Salut i Consum del Govern de les Illes Balears
Repositorio:Docusalut
Idioma:inglés
OAI Identifier:oai:docusalut.com:20.500.13003/26474
Acesso em linha:https://hdl.handle.net/20.500.13003/26474
Access Level:acceso abierto
Palavra-chave:Leukemia, Myeloid, Acute
Cardio-Oncology
Cardiotoxicity
Cyclophosphamide
Leucemia Mieloide Aguda
Cardiooncología
Cardiotoxicidad
Ciclofosfamida
acute myeloid leukemia
cardio-oncology
cardiotoxicity
post-transplant cyclophosphamide
Descrição
Resumo:Background: Post-transplant cyclophosphamide (PTCy) is a standard graft-versus-host disease (GVHD) prophylaxis in allogeneic hematopoietic cell transplantation (allo-HCT). While effective, concerns remain about cyclophosphamide-related cardiotoxicity, especially in patients with pre-existing cardiac morbidity, a population often underrepresented in clinical trials. Objectives: To assess the incidence and outcomes of early (ECE, ≤100 days) and late (LCE, >100 days) cardiac events in acute myeloid leukemia (AML) patients with and without baseline cardiac morbidity undergoing allo-HCT with PTCy. Study Design: Retrospective multicenter study by the Grupo Español de Trasplante Hematopoyético y Terapia Celular (GETH-TC) including 461 AML patients (62 with cardiac morbidity) transplanted between 2012 and 2022. Cardiac morbidity was defined by documented cardiac disease or left ventricular ejection fraction < 45%. Cumulative incidence, overall survival (OS), and non-relapse mortality (NRM) were analyzed using competing risks models and adjusted with propensity score matching (PSM) and inverse probability weighting (IPW). Results: Cardiac events occurred in 13.2% of patients: 11% vs. 7% ECE (p = 0.93) and 8% vs. 5.3% LCE (p = 0.85) in those with vs. without cardiac morbidity. Most ECEs were arrhythmias or heart failure. Adjusted analyses confirmed no significant differences in CE incidence, OS, or NRM between groups. Two-year OS was 69% vs. 70% (p = 0.50); NRM was 18% vs. 17% (p = 0.20). ECE was associated with higher mortality in both groups. Conclusions: PTCy is feasible in AML patients with pre-existing cardiac morbidity when combined with comprehensive cardiovascular evaluation and cardio-oncology follow-up, supporting its safe use in broader patient populations with appropriate cardiologic support.

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