NT-proBNP Levels after First-Dose Post-Transplant Cyclophosphamide Predict Early Cardiac Events and Mortality in...

Area of Science:

• Hematology
• Cardiology
• Oncology

Background:

• Post-transplant cyclophosphamide (PTCy) is crucial for preventing graft-versus-host disease (GVHD) after haploidentical stem cell transplantation (HSCT).
• PTCy is linked to significant toxicities, notably an increased risk of early cardiac events (ECEs).

Purpose of the Study:

• To determine if dynamic changes in N-terminal pro-B-type natriuretic peptide (BNP) levels following PTCy administration can predict ECEs and clinical outcomes.
• To assess BNP as a potential biomarker for cardiotoxicity in haploidentical HSCT recipients.

Main Methods:

• Retrospective analysis of 134 patients undergoing haploidentical HSCT with PTCy-based GVHD prophylaxis.
• BNP levels measured post-day +3 and pre-day +4 PTCy doses.
• Univariate and multivariate analyses correlated BNP levels with ECEs, relapse, nonrelapse mortality (NRM), GVHD, graft-versus-host disease-free, relapse-free survival (GRFS), and overall survival (OS).

Main Results:

• The cumulative incidence of ECEs was 17.9%.
• Elevated BNP levels (>530 pg/mL) significantly correlated with higher ECE incidence (63% vs. 3.9%), NRM (3-year: 67% vs. 28%), worse OS (3-year: 12% vs. 39%), and inferior GRFS (3-year: 5% vs. 28%).
• Multivariate analysis identified high BNP levels as a strong predictor for ECEs (HR: 19.0) and NRM (HR: 2.54).

Conclusions:

• Elevated BNP levels post-PTCy are significantly associated with increased ECEs, NRM, and inferior OS in haploidentical HSCT.
• BNP monitoring after the initial PTCy dose may serve as a predictive biomarker for cardiotoxicity.
• BNP levels could potentially guide PTCy dose adjustments to prevent ECEs.