Cardiac events after allo-HCT in patients with acute myeloid leukemia

Area of Science:

• Hematology
• Cardiology
• Oncology

Background:

• Acute myeloid leukemia (AML) patients undergoing allogeneic hematopoietic stem cell transplantation (allo-HCT) face risks of cardiac complications.
• Anthracyclines are commonly used in AML treatment, potentially increasing cardiac event (CE) risk.
• The role of post-transplant cyclophosphamide (PTCY) in cardiac complications and its impact on survival outcomes requires further investigation.

Purpose of the Study:

• To investigate the incidence and predictors of early (ECEs) and late cardiac events (LCEs) after allo-HCT in AML patients.
• To evaluate the impact of PTCY on cardiac complications.
• To assess the effect of CEs on overall survival (OS) and non-relapse mortality (NRM).

Main Methods:

• Multicenter study including 1020 AML patients who underwent allo-HCT.
• Analysis of early (within 100 days) and late cardiac events (arrhythmias, pericardial complications, heart failure).
• Multivariate regression analyses to determine predictors of CEs and their impact on OS and NRM, and the effect of PTCY.

Main Results:

• Overall, 9.2% of patients experienced CEs; ECEs occurred in 4.8% and LCEs in 4.4%.
• PTCY use was associated with an increased risk of ECEs (HR, 2.86; P = .007) but not LCEs (HR, 1.06; P = .892).
• Cardiac events significantly decreased OS (HR, 1.66; P = .005) and increased NRM (HR, 2.88; P < .001). PTCY use improved OS (HR, 0.71; P = .026).

Conclusions:

• Cardiac events, though relatively low in incidence, significantly impact mortality in AML patients post-allo-HCT.
• Standard-dose PTCY increases the risk of early cardiac events but is associated with improved overall survival.
• There is a need for protocols to prevent cardiac complications in AML patients undergoing allo-HCT, balancing treatment benefits and risks.