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Multicenter Study
. 2025 May 1:16:1571678.
doi: 10.3389/fimmu.2025.1571678. eCollection 2025.

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

Filipe R Pinto  1 , Enric Cascos  2 , Estefanía Pérez-López  3 , Mónica Baile-González  3 , Carlos Martín Rodríguez  3 , María Jesús Pascual Cascón  4 , Marta Luque  4 , Albert Esquirol  5 , Carmen Martín Calvo  6 , Felipe Peña-Muñóz  7 , Inmaculada Heras Fernando  8 , Itziar Oiartzabal Ormtegi  9 , Adolfo Jesús Sáez Marín  10 , Sara Fernández-Luis  11 , Juan José Domínguez-García  11 , Sara Villar Fernández  12 , José Luis López Lorenzo  13 , Miguel Fernández de Sanmamed Girón  14 , Leslie González Pinedo  14 , Lucía García  15 , Ana Pilar González-Rodriguez  16 , Tamara Torrado  17 , Silvia Filaferro  18 , Pascual Basalobre  18 , Alberto López-García  13 , Guillermo Ortí  18   19 , Manuel Jurado Chacón  18   20 , María Queralt Salas  2   21
Affiliations
Multicenter Study

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

Filipe R Pinto et al. Front Immunol. .

Abstract

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.

Keywords: AML; GVHD prophylaxis; Haplo-HCT; PTCY; cardiovascular toxicity; early cardiac events.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Risk factors for early cardiac events.
Figure 2
Figure 2
Main outcomes.
See this image and copyright information in PMC

References

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