Researchers Find Low Incidence of Cardiac Toxicity with Post-Transplant Cyclophosphamide

Post-transplant cyclophosphamide (PTCy) has shown promise in managing graft-versus-host-disease (GVHD) for patients undergoing allogeneic hematopoietic cell transplantation (alloHCT), but cyclophosphamide has also been associated with cardiac toxicities.

In a retrospective analysis of matched alloHCT patients from a single center who were treated with PTCy or non–PTCy-based GVHD prophylaxis, researchers found that the incidence of acute cardiac toxicity up to 100 days after transplant remained low and manageable. The findings were published in Blood Advances.

Investigators reviewed data from 585 patients: 272 who received PTCy prophylaxis and 313 who received non–PTCy-based prophylaxis. Overall, 38 patients (6.5%) experienced cardiac toxicities after alloHCT. The toxicities observed included:

  • arrhythmias (n = 21)
  • heart failure (n = 14)
  • pericardial effusions (n = 10)
  • myocardial infarction or ischemia (n = 7)

The incidence of cardiac toxicities was slightly higher among patients who received PTCy, at 7.4%, compared with those who received non–PTCy-based prophylaxis, at 5.8% (P=0.4).

The researchers found that age >55 years (P=0.02), history of hypertension (P=0.01), arrhythmia (P=0.003), diabetes (P=0.04), and cardiac comorbidities (P<0.001) were significant predictors of cardiac toxicity. However, none of the preparative and GVHD prophylaxis regimens used were predictive of cardiac toxicity.

“From these findings, we proposed the use of a Cardiac Risk Stratification Score to quantify the risk of cardiac toxicity following alloHCT and found that a higher score correlated with cardiac toxicity incidence,” the authors concluded. “Furthermore, the development of cardiac toxicity was associated with worse one-year overall survival and non-relapse mortality while the use of PTCy was associated with improvements in one-year overall survival and non-relapse mortality rates.”