Post-transplant cyclophosphamide-induced cardiotoxicity: A comprehensive review

Area of Science:

• Cardiology
• Oncology
• Toxicology

Background:

• Cyclophosphamide (CP) is a widely used chemotherapy agent.
• CP-induced cardiotoxicity is a serious adverse effect, linked to its metabolite acrolein.
• Cardiotoxicity can occur even with low-dose CP, particularly in hematopoietic stem cell transplantation (HSCT) recipients.

Purpose of the Study:

• To review the challenges of CP therapy in HSCT recipients.
• To discuss mechanisms of CP-induced cardiotoxicity.
• To explore therapeutic strategies targeting acrolein.

Main Methods:

• Literature review of studies on cyclophosphamide therapy and cardiotoxicity.
• Analysis of signaling pathways involved in CP-induced cardiomyopathy.
• Evaluation of acrolein's role and potential therapeutic interventions.

Main Results:

• High-dose CP poses significant cardiotoxicity risks.
• Low-dose CP also presents cardiotoxicity concerns in post-HSCT patients.
• Acrolein's anti-angiogenic effect is a key factor in CP cardiotoxicity.

Conclusions:

• Managing CP-induced cardiotoxicity in HSCT recipients remains challenging.
• Understanding acrolein's mechanisms is crucial for developing effective treatments.
• Targeting acrolein's anti-angiogenic effects shows promise for mitigating CP cardiotoxicity.