Predicting cardiovascular events in allogeneic hematopoietic stem cell transplant recipients

Abstract Aims Patients undergoing allogeneic hematopoietic stem cell transplantation (alloHSCT) are at increased risk of cardiovascular complications; however, comprehensive data on these risks in large cohorts remain limited. This study aims to identify predictors of cardiovascular events in a large cohort of alloHSCT patients. Methods We conducted a retrospective monocentric study including all consecutive patients aged 15 years and older with haematological malignancies who underwent alloHSCT between 2011 and 2020. Data were extracted from electronic medical records, including demographic, clinical, and transplant-specific variables. The primary composite outcome was cardiotoxicity including cardiovascular death, heart failure (HF), rhythm/conduction disorders, acute arterial events, venous thromboembolism (VTE), and myopericarditis. Predictors of cardiotoxicity were analysed using Cox proportional hazards regression and Fine-and-Gray models. Results Among 1,027 patients recruited (age 45±16 years, 62% male), 30% experienced cardiotoxicity after a median (interquartile range, IQR) follow-up of 4 (1-7) years. The median (IQR) time to the first event was 8 months (3-17). In multivariable analysis, independent predictors for early events (≤100 days) were age, hypertension, history of HF, cancer therapy-related cardiac dysfunction (CTRCD), and high-dose administration of cyclophosphamide (≥100 mg/kg). For late events (>100 days), independent predictors were age, hypertension, history of VTE, atrial fibrillation/flutter, history of HF, CTRCD, previous liposomal anthracycline exposure, and high-risk hematopoietic cell transplantation-comorbidity index(HCT-CI) score category. Conclusion Our study identifies independent predictors of early and late cardiotoxicity, including demographic data, cardiovascular risk factors, history of cardiovascular disease and oncologic history.