A common cause of nonrelapse mortality among people who undergo allogeneic hematopoietic stem cell transplantation (alloHCT) is graft-versus-host disease (GVHD). Many patients receive posttransplant cyclophosphamide (PTCy) to help them manage the condition, but it comes at a cost: PTCy is associated with cardiac toxicities.
A team of researchers affiliated with the University of Texas MD Anderson Cancer Center conducted a retrospective analysis of 585 patients who underwent alloHCT and received either PTCy-based or non-PTCy-based GVHD prophylaxis (272 and 313 patients, respectively). They sought to determine the incidence of cardiac toxicity at day +100 and the risk factors associated with its development after matched alloHCT. Their findings were published in Blood Advances.
PTCy-based GVHD is associated with improved 1-year overall survival (OS) and 1-year nonrelapse mortality (NRM). However, development of cardiac toxicity is associated with worse OS and NRM at 1 year.
Certain factors were found to increase the risk of experiencing cardiac toxicities: age older than 55; hypertension; and the cardiac, arrhythmia, and diabetes components of the Hematopoietic Cell Transplantation-specific Comorbidity Index (HCT-CI) score.
Overall incidence of cardiac toxicities was 6.5%. Incidence among patients who received PTCy-based GVHD prophylaxis was 7.4%, with 9 of 20 (45%) patients experiencing multiple toxicities. Among patients who received non-PTCy-based prophylaxis, incidence was 5.8% (P =.4), with 5 of 18 (28%) patients experiencing multiple toxicities.
On analysis, a total of 52 cardiac toxicities developed in 38 patients by day +100, including arrhythmias (21), heart failure (14), pericardial effusions (10), and myocardial infarction or ischemia (7).
The researchers proposed using a Cardiac Risk Stratification Score to assess a patient’s risk of experiencing such toxicities, as a higher score on that scale would indicate a higher incidence of cardiac toxicity. That can inform providers about when it may be beneficial to proceed in using PTCy in patients with limited cardiac comorbidities, due to its positive effect on 1-year survival and NRM.
“The results of our study suggest that the incidence of cardiac toxicities is low in this current era of PTCy-based GVHD prophylaxis and that PTCy does not impact the development of acute cardiac toxicities after matched alloHCT,” the researchers stated. Improved survival and toxicity outcomes in this study provides further support that PTCy may be utilized in patients with limited cardiac comorbidities, they concluded.
The study was limited by its nature as a retrospective, single-center study and lack of long-term follow-up.
Yeh J, Whited L, Saliba RM, et al. Cardiac toxicity after matched allogeneic hematopoietic cell transplantation in the post-transplant cyclophosphamide era. Blood Adv. Published online September 30, 2021. doi:10.1182/bloodadvances.2021004846