Risk factors and survival outcomes in children with early cardiotoxicity after allogeneic hematopoietic stem cell...

Area of Science:

• Pediatric Hematology/Oncology
• Cardiology
• Transplantation Medicine

Background:

• Cardiotoxicity is a severe complication following pediatric allogeneic hematopoietic stem cell transplantation (allo-HSCT).
• Limited data exists on early-stage cardiotoxicity characteristics and risk factors in this vulnerable population.
• Early identification of cardiac risks is crucial for improving patient prognosis after allo-HSCT.

Purpose of the Study:

• To evaluate the clinical characteristics of early cardiac events (ECEs) in pediatric patients post-allo-HSCT.
• To identify risk factors associated with the development of ECEs.
• To assess the impact of ECEs on overall survival (OS) and nonrelapse mortality (NRM).

Main Methods:

• Retrospective single-center study of 444 pediatric patients undergoing allo-HSCT (January 2016 - December 2022).
• Analysis of ECEs including valvular disease, pericardial effusion, arrhythmia, heart failure, and dilated cardiomyopathy.
• Development of a stratified cardiac risk score based on identified risk factors.

Main Results:

• 16.4% of patients (73/444) experienced ECEs.
• Risk factors for ECEs included female sex, age ≥ 6 years, BMI < 16 kg/m², and HLA-type mismatches.
• Higher cardiac risk scores correlated with increased ECE incidence.
• ECE occurrence significantly reduced OS rates and increased NRM.
• Multiple ECEs showed a more pronounced negative impact on OS.

Conclusions:

• Female sex, older age, low BMI, and HLA mismatches are significant risk factors for ECEs post-pediatric allo-HSCT.
• A novel stratified cardiac risk score effectively predicts ECE risk.
• ECEs negatively impact survival outcomes, emphasizing the need for proactive cardiac monitoring in pediatric allo-HSCT recipients.