Author + information
- Chien-Jung Lin,
- Michael Slade,
- Justin Vader and
- Rizwan Romee
Background: The use of post-transplant cyclophosphamide (PT-Cy) has contributed significantly to the success of haploidentical hematopoietic cell transplant, which expands the potential donor pool for patients needing hematopoietic cell transplantation (HCT). However, use of high dose cyclophosphamide has been associated with the development of cardiomyopathy. There is paucity of data concerning post-transplant cardiomyopathy in patients receiving PT-Cy based HCT.
Methods: A retrospective analysis was performed on 176 patients receiving haploidentical, matched related, or matched unrelated HCT with PT-Cy in a tertiary care center. Overall survival, left ventricular ejection fraction (LVEF), brain natriuretic peptide (BNP) levels, and cardiac comorbidities were reviewed. The associations between comorbidities and the onset of cardiomyopathy were assessed using a Cox proportional hazard model.
Results: Pre-transplant cardiomyopathy was found in 16 patients (9.1%), but had no effect on their post transplant overall survival. A mean reduction of 6% in LVEF was found after HCT. Thirty-five patients (21.9%) developed post-transplant cardiomyopathy, which correlated with increased mortality. However, the majority of these cardiomyopathies occurred in the setting of an infectious milieu, and 9 (25.7%) had documented recovery. Age and history of diabetes were the only traditional cardiovascular risk factors found to correlate with post-transplant cardiomyopathy.
Conclusions: The presence of pre-transplant cardiomyopathy does not negatively impact overall survival in patients who receive PT-Cy for graft versus host disease prophylaxis. Further, cardiomyopathy in PT-Cy patients is mostly concurrent with infectious complications and is associated with reduced overall survival. Traditional cardiovascular risk factors do not fully predict the occurrence of post-transplant cardiomyopathy. Future research is required to unravel predictive factors for cardiomyopathy after PT-Cy-based HCT.
Poster Hall, Hall C
Sunday, March 19, 2017, 9:45 a.m.-10:30 a.m.
Session Title: The Evolving World of LVADs, Transplant and Other Novel Discoveries
Abstract Category: 13. Heart Failure and Cardiomyopathies: Clinical
Presentation Number: 1294-272
- 2017 American College of Cardiology Foundation