Early cardiac events after haploidentical hematopoietic cell transplantation with post-transplant cyclophosphamide. subanalysis exploring cardiac toxicity conducted on behalf of GETH-TC

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 ca...

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Autores: Pinto, Filipe R., Cascos, Enric, Pérez López, Estefanía, Baile González, Mónica, Martín Rodríguez, Carlos, Pascual Cascón, María Jesús, Luque, Marta, Esquirol, Albert, Calvo, Carmen Martín, Peña Muñóz, Felipe, Fernando, Inmaculada Heras, Oiartzabal Ormtegi, Itziar, Sáez Marín, Adolfo Jesús, Fernández Luis, Sara, Domínguez García, Juan José, Fernández, Sara Villar, López Lorenzo, José Luis, Girón, Miguel Fernández de Sanmamed, Pinedo, Leslie González, García, Lucía
Formato: artículo
Fecha de publicación:2025
País:España
Recursos:Universidad de Cantabria (UC)
Repositorio:UCrea Repositorio Abierto de la Universidad de Cantabria
Idioma:inglés
OAI Identifier:oai:repositorio.unican.es:10902/37458
Acesso em linha:https://hdl.handle.net/10902/37458
Access Level:acceso abierto
Palavra-chave:Haplo-HCT
PTCY
Early cardiac events
Cardiovascular toxicity
AML
GVHD prophylaxis
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spelling Early cardiac events after haploidentical hematopoietic cell transplantation with post-transplant cyclophosphamide. subanalysis exploring cardiac toxicity conducted on behalf of GETH-TCPinto, Filipe R.Cascos, EnricPérez López, EstefaníaBaile González, MónicaMartín Rodríguez, CarlosPascual Cascón, María JesúsLuque, MartaEsquirol, AlbertCalvo, Carmen MartínPeña Muñóz, FelipeFernando, Inmaculada HerasOiartzabal Ormtegi, ItziarSáez Marín, Adolfo JesúsFernández Luis, SaraDomínguez García, Juan JoséFernández, Sara VillarLópez Lorenzo, José LuisGirón, Miguel Fernández de SanmamedPinedo, Leslie GonzálezGarcía, LucíaHaplo-HCTPTCYEarly cardiac eventsCardiovascular toxicityAMLGVHD prophylaxisIntroduction: 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.Frontiers Research FoundationUniversidad de Cantabria20252025-01-01journal articlehttp://purl.org/coar/resource_type/c_6501NAhttp://purl.org/coar/version/c_be7fb7dd8ff6fe43info:eu-repo/semantics/articlehttps://hdl.handle.net/10902/37458Frontiers in Immunology, 2025, 16, 1571678reponame:UCrea Repositorio Abierto de la Universidad de Cantabriainstname:Universidad de Cantabria (UC)Inglésengopen accesshttp://purl.org/coar/access_right/c_abf2Attribution 4.0 Internationalhttp://creativecommons.org/licenses/by/4.0/info:eu-repo/semantics/openAccessoai:repositorio.unican.es:10902/374582026-06-02T12:39:31Z
dc.title.none.fl_str_mv Early cardiac events after haploidentical hematopoietic cell transplantation with post-transplant cyclophosphamide. subanalysis exploring cardiac toxicity conducted on behalf of GETH-TC
title Early cardiac events after haploidentical hematopoietic cell transplantation with post-transplant cyclophosphamide. subanalysis exploring cardiac toxicity conducted on behalf of GETH-TC
spellingShingle Early cardiac events after haploidentical hematopoietic cell transplantation with post-transplant cyclophosphamide. subanalysis exploring cardiac toxicity conducted on behalf of GETH-TC
Pinto, Filipe R.
Haplo-HCT
PTCY
Early cardiac events
Cardiovascular toxicity
AML
GVHD prophylaxis
title_short Early cardiac events after haploidentical hematopoietic cell transplantation with post-transplant cyclophosphamide. subanalysis exploring cardiac toxicity conducted on behalf of GETH-TC
title_full Early cardiac events after haploidentical hematopoietic cell transplantation with post-transplant cyclophosphamide. subanalysis exploring cardiac toxicity conducted on behalf of GETH-TC
title_fullStr Early cardiac events after haploidentical hematopoietic cell transplantation with post-transplant cyclophosphamide. subanalysis exploring cardiac toxicity conducted on behalf of GETH-TC
title_full_unstemmed Early cardiac events after haploidentical hematopoietic cell transplantation with post-transplant cyclophosphamide. subanalysis exploring cardiac toxicity conducted on behalf of GETH-TC
title_sort Early cardiac events after haploidentical hematopoietic cell transplantation with post-transplant cyclophosphamide. subanalysis exploring cardiac toxicity conducted on behalf of GETH-TC
dc.creator.none.fl_str_mv Pinto, Filipe R.
Cascos, Enric
Pérez López, Estefanía
Baile González, Mónica
Martín Rodríguez, Carlos
Pascual Cascón, María Jesús
Luque, Marta
Esquirol, Albert
Calvo, Carmen Martín
Peña Muñóz, Felipe
Fernando, Inmaculada Heras
Oiartzabal Ormtegi, Itziar
Sáez Marín, Adolfo Jesús
Fernández Luis, Sara
Domínguez García, Juan José
Fernández, Sara Villar
López Lorenzo, José Luis
Girón, Miguel Fernández de Sanmamed
Pinedo, Leslie González
García, Lucía
author Pinto, Filipe R.
author_facet Pinto, Filipe R.
Cascos, Enric
Pérez López, Estefanía
Baile González, Mónica
Martín Rodríguez, Carlos
Pascual Cascón, María Jesús
Luque, Marta
Esquirol, Albert
Calvo, Carmen Martín
Peña Muñóz, Felipe
Fernando, Inmaculada Heras
Oiartzabal Ormtegi, Itziar
Sáez Marín, Adolfo Jesús
Fernández Luis, Sara
Domínguez García, Juan José
Fernández, Sara Villar
López Lorenzo, José Luis
Girón, Miguel Fernández de Sanmamed
Pinedo, Leslie González
García, Lucía
author_role author
author2 Cascos, Enric
Pérez López, Estefanía
Baile González, Mónica
Martín Rodríguez, Carlos
Pascual Cascón, María Jesús
Luque, Marta
Esquirol, Albert
Calvo, Carmen Martín
Peña Muñóz, Felipe
Fernando, Inmaculada Heras
Oiartzabal Ormtegi, Itziar
Sáez Marín, Adolfo Jesús
Fernández Luis, Sara
Domínguez García, Juan José
Fernández, Sara Villar
López Lorenzo, José Luis
Girón, Miguel Fernández de Sanmamed
Pinedo, Leslie González
García, Lucía
author2_role author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
dc.contributor.none.fl_str_mv Universidad de Cantabria
dc.subject.none.fl_str_mv Haplo-HCT
PTCY
Early cardiac events
Cardiovascular toxicity
AML
GVHD prophylaxis
topic Haplo-HCT
PTCY
Early cardiac events
Cardiovascular toxicity
AML
GVHD prophylaxis
description 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.
publishDate 2025
dc.date.none.fl_str_mv 2025
2025-01-01
dc.type.none.fl_str_mv journal article
http://purl.org/coar/resource_type/c_6501
NA
http://purl.org/coar/version/c_be7fb7dd8ff6fe43
dc.type.openaire.fl_str_mv info:eu-repo/semantics/article
format article
dc.identifier.none.fl_str_mv https://hdl.handle.net/10902/37458
url https://hdl.handle.net/10902/37458
dc.language.none.fl_str_mv Inglés
eng
language_invalid_str_mv Inglés
language eng
dc.rights.none.fl_str_mv open access
http://purl.org/coar/access_right/c_abf2
Attribution 4.0 International
http://creativecommons.org/licenses/by/4.0/
dc.rights.openaire.fl_str_mv info:eu-repo/semantics/openAccess
rights_invalid_str_mv open access
http://purl.org/coar/access_right/c_abf2
Attribution 4.0 International
http://creativecommons.org/licenses/by/4.0/
eu_rights_str_mv openAccess
dc.publisher.none.fl_str_mv Frontiers Research Foundation
publisher.none.fl_str_mv Frontiers Research Foundation
dc.source.none.fl_str_mv Frontiers in Immunology, 2025, 16, 1571678
reponame:UCrea Repositorio Abierto de la Universidad de Cantabria
instname:Universidad de Cantabria (UC)
instname_str Universidad de Cantabria (UC)
reponame_str UCrea Repositorio Abierto de la Universidad de Cantabria
collection UCrea Repositorio Abierto de la Universidad de Cantabria
repository.name.fl_str_mv
repository.mail.fl_str_mv
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score 15.812455

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