Early Cardiovascular Events in Recipients of Allogeneic Hematopoietic Stem Cell Transplantation

Allogeneic hematopoietic stem cell transplantation (HSCT) is associated with organ toxicities, including cardiovascular (CV) complications. Data on contemporary acute postallogeneic HSCT cardiac complications and their impact on survival are scant.

The aim of the study was to determine the incidence of early CV events following allogeneic HSCT and their effect on survival within the first 100 days.

We conducted a single-center retrospective cohort study of adult patients who underwent allogeneic HSCT between 2004 and 2022. CV outcomes were a composite of CV death, myocardial infarction, heart failure, arrhythmia, stroke, or transient ischemic attack in early (≤100 days) postallogeneic HSCT.

The 100-day cumulative incidences of CV events in 852 patients (median age: 54 years; 58.57% male) was 5.55% (95% CI: 4.13%-7.26%). The most frequent cardiac event was atrial arrhythmia (cumulative incidence: 3.92% [95% CI: 2.84%-5.56%]), followed by heart failure (cumulative incidence: 2.07% [95% CI: 1.26%-3.24%]). Age (subhazard ratio [SHR] per year: 1.07; 95% CI: 1.03-1.13) and left ventricular ejection fraction <50% before transplant (SHR: 3.16; 95% CI: 1.43-6.98) were independently associated with increased risk of CV events. Nonfatal CV events during the first 100 days were independently associated with an increased hazard of nonrelapse mortality (SHR: 6.25; 95% CI: 2.83-13.79) and all-cause mortality (HR: 5.79; 95% CI: 2.87-11.68).

Although CV events are relatively uncommon in the first 100 days in patients after allogeneic HSCT, the occurrence of CV events is associated with high nonrelapse and all-cause mortality rates. Close monitoring of patients who develop CV events is recommended.