Effect of cumulative daunorubicin dose on cardiotoxicity after allogeneic stem cell transplantation

Area of Science:

• Hematology
• Oncology
• Cardiology

Background:

• Cardiotoxicity is a significant complication following allogeneic stem cell transplantation (SCT), leading to mortality and reduced quality of life.
• The precise relationship between daunorubicin dosage and the development of cardiotoxicity post-SCT remains incompletely understood.

Purpose of the Study:

• To investigate the association between cumulative daunorubicin dose and the incidence of cardiotoxicity in patients undergoing allogeneic SCT for acute myeloid leukemia (AML).
• To identify specific daunorubicin dose thresholds that may serve as independent risk factors for cardiotoxicity.

Main Methods:

• Retrospective analysis of 171 patients with AML who received their first allogeneic SCT between 2005 and 2021.
• Evaluation of daunorubicin cumulative doses, including patients receiving two induction courses (≥500 mg/m²).
• Assessment of cardiotoxicity incidence and correlation with clinical factors, including left ventricular ejection fraction (LVEF) and daunorubicin dose.

Main Results:

• The cumulative incidence of cardiotoxicity at 2 years post-SCT was 7.1% (12 patients).
• Univariable analysis identified female sex, pre-SCT LVEF <60%, and daunorubicin doses ≥500 mg/m² as associated with cardiotoxicity.
• Multivariable analysis confirmed that a daunorubicin dose of ≥500 mg/m² is an independent risk factor for cardiotoxicity, also linked to decreased pre-SCT LVEF.

Conclusions:

• Second induction therapy with high-dose daunorubicin (≥500 mg/m²) is a significant risk factor for cardiotoxicity after allogeneic SCT.
• This dose threshold should be considered when planning reinduction therapies for AML patients eligible for SCT, balancing efficacy with cardiac risk.