Factors affecting the development of atrial fibrillation and atrial flutter (AF/AFL) following autologous hematopoietic SCT (auto-HSCT)

Steuter, John; Villanueva, M. L H; Loberiza, Fausto R.; Armitage, Jamés O.; Bociek, R. Gregory; Ganti, Apar Kishor; Tarantolo, Stephano R.; Vose, Julie M.; Easley, Arthur R.; Bierman, Philip J.

doi:10.1038/bmt.2012.253

Cited by 16 publications

(5 citation statements)

References 12 publications

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“…To date, studies examining AF after HCT have been limited to patients undergoing autologous HCT, [32][33][34][35][36][37][38] representing an older population with greater comorbidities and a higher proportion of pre-HCT cardiotoxic (eg, chest radiation and anthracyclines) exposures, compared with patients undergoing allogeneic HCT. To our knowledge, our study is the first to describe the incidence and risk factors for AF in a contemporary cohort of allogeneic patients, allowing us to capture evolving HCT practices (eg, expanding donor stemcell source, use of nonmyeloablative conditioning, increasingly older age at HCT, and expanded indications for HCT).…”

Section: Discussionmentioning

confidence: 99%

Atrial Fibrillation in Patients Undergoing Allogeneic Hematopoietic Cell Transplantation

Chang

Chanson

Teh

et al. 2021

JCO

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PURPOSE To examine the incidence and risk factors for de novo atrial fibrillation (AF) after allogeneic hematopoietic cell transplantation (HCT) and to describe the impact of AF on HCT-related outcomes. METHODS A retrospective cohort study design was used to examine AF and associated outcomes in 487 patients who underwent allogeneic HCT from 2014 to 2016 and to characterize patient- and HCT-related risk factors. A nested case-control study design was used to describe the association between pre-HCT echocardiographic measures and future AF events. RESULTS The median age at HCT was 52.4 years (18.1-78.6); the median time to AF was 117.5 days (4.0-1,405.0). The 5-year cumulative incidence of AF was 10.6%. Older (≥ 50 years) age (hazard ratio [HR], 2.76; 95% CI, 1.37 to 5.58), HLA-unrelated donor (HR, 2.20; 95% CI, 1.18 to 4.12), dyslipidemia (HR, 2.40; 95% CI, 1.23 to 4.68), and pre-HCT prolonged QTc interval (HR, 2.55; 95% CI, 1.38 to 4.72) were independent risk factors for AF. Despite having comparable left ventricular systolic function, patients who developed AF were significantly more likely to have lower left atrial ejection fraction, left atrial reservoir function, and elevated tricuspid regurgitant jet velocity prior to HCT, compared with patients who did not. The incidence rate of stroke after AF was 143 per 1,000 person-years. In adjusted analyses, AF was associated with a 12.8-fold (HR, 12.76; 95% CI, 8.76 to 18.57) risk of all-cause mortality and 15.8-fold (HR, 15.78; 95% CI, 8.70 to 28.62) risk of nonrelapse mortality. CONCLUSION The burden of AF after allogeneic HCT population is substantial, and the development of AF is associated with poor survival. We identified important associations between patient demographics, pre-HCT cardiac parameters, HCT-related exposures, and risk of AF, setting the stage for targeted prevention strategies during and after HCT.

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Section: Discussionmentioning

confidence: 99%

Atrial Fibrillation in Patients Undergoing Allogeneic Hematopoietic Cell Transplantation

Chang

Chanson

Teh

et al. 2021

JCO

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“…31 articles were additionally excluded from full‐length review as they did not report the arrhythmia incidence or mortality risk/rate associated with arrhythmias in HSCT patients, and 23 articles were excluded because they were not observational studies. Ultimately, 13 cohort studies consisting of 10 587 HSCT patients were enrolled . The literature retrieval, review, and selection process are demonstrated in Figure .…”

Section: Resultsmentioning

confidence: 99%

“…Ultimately, 13 cohort studies consisting of 10 587 HSCT patients were enrolled. 1,3,7,[17][18][19][20][21][22][23][24][25][26] The literature retrieval, review, and selection process are demonstrated in Figure 1. The characteristics of the included studies are presented in Table 1.…”

Section: Re Sultmentioning

confidence: 99%

Arrhythmias in hematopoietic stem cell transplantation: A systematic review and meta‐analysis

Chiengthong

Lertjitbanjong

Sharma

et al. 2019

European J of Haematology

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Background: There are controversial data regarding the relationship between hematopoietic stem cell transplantation and arrhythmias. This meta-analysis was performed to evaluate the incidence of arrhythmias in patients following hematopoietic stem cell transplantation (HSCT). Methods: A literature search was conducted utilizing MEDLINE, EMBASE, andCochrane Databases from inception through April 2019. Pooled incidence with 95% confidence interval (CI) were calculated using random-effects meta-analysis. The protocol for this meta-analysis is registered with PROSPERO (International Prospective Register of Systematic Reviews; no. CRD42019131833). Results:Thirteen studies consisting of 10,587 patients undergoing HSCT were enrolled in this systematic review. Overall, the pooled estimated incidence of all types of arrhythmias following HSCT was 7.2% (95% CI: 4.9%-10.5%). With respect to the most common type of arrhythmia, the pooled estimated incidence of atrial fibrillation/atrial flutter (AF/AFL) within 30 days following HSCT was 4.2% (95% CI:1.7%-9.6%). Egger's regression test demonstrated no significant publication bias in this meta-analysis of post-HSCT arrhythmia incidence. Conclusion:The overall estimated incidence of arrhythmias following HSCT was 7.2%. Future large scale studies are needed to further elucidate the significance and clinical impact of arrhythmias in post-HSCT patients. K E Y W O R D Satrial fibrillation, bone marrow transplantation, meta-analysis, stem cell transplantation, supraventricular tachycardia | 565 CHIENGTHONG ET al.

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“…These patients showed a higher average heart rate ( P < 0.00010) and lower parasympathetic control ( P < 0.001) than the healthy group. [ 25 ] Steuter et al [ 26 ] retrospectively studied 516 patients who received auto-HCT and found that a history of arrhythmia was a risk factor for developing AF/AFL following HCT (odds ratio: 9.33, P < 0.001). However, the clinical impact of post-HCT arrhythmia needs to be further elucidated.…”

Section: Discussionmentioning

confidence: 99%

Increased risk of cardio-cerebrovascular disease after hematopoietic cell transplantation in patients with previous history

Peng

Wang

Dou

et al. 2021

Chinese Medical Journal

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Background: The impacts of previous cardio-cerebrovascular disease (pre-CCVD) on the outcomes of hematopoietic cell transplantation (HCT) are not well described. Patients with pre-CCVD may often be poor candidates for HCT. This study aimed to investigate the impact of pre-CCVD on transplant outcomes. Methods: A retrospective study was conducted between patients with and without pre-CCVD who consecutively received allogeneic or autologous HCT between November 2013 and January 2020 with a matching of age and disease status. The cardiovascular complications and HCT outcomes of the two groups were evaluated and compared. The primary endpoints were post-transplant cardio-cerebrovascular disease (post-CCVD) and non-relapse mortality (NRM). We used a multivariable Cox proportional hazard model and the Fine-Gray competing risk regressions for analyses to estimate the hazard ratios (HRs). Results: The outcomes of 23 HCT recipients with pre-CCVD were compared with those of 107 patients in the control group. No significant differences were noted in terms of engraftment, overall survival (OS) (67.00% vs. 67.90%, P = 0.983), or relapse (29.78% vs. 28.26%, P = 0.561) between the pre-CCVD group and the control group. The cumulative incidences of 2-year NRM were similar between patients with pre-CCVD and the controls (14.68% vs. 17.08%, P = 0.670). However, pre-CCVD was associated with an increased incidence of post-CCVD (HR: 12.50, 95% confidence interval [CI]: 3.88–40.30, P < 0.001), which was an independent risk factor for increased NRM (HR: 10.29, 95% CI: 3.84–27.62, P < 0.001) and inferior OS (HR: 10.29, 95% CI: 3.84–27.62, P < 0.001). Conclusions: These findings suggest that the existence of pre-CCVD before transplantation might not result in increased mortality directly but superpose the toxicity of the transplantation procedure, leading to a risk of post-CCVD. Post-CCVD was a powerful predictor for high NRM and inferior OS. Further risk stratification of pre-CCVD is needed to reduce NRM in various transplantation settings.

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Factors affecting the development of atrial fibrillation and atrial flutter (AF/AFL) following autologous hematopoietic SCT (auto-HSCT)

Cited by 16 publications

References 12 publications

Atrial Fibrillation in Patients Undergoing Allogeneic Hematopoietic Cell Transplantation

Atrial Fibrillation in Patients Undergoing Allogeneic Hematopoietic Cell Transplantation

Arrhythmias in hematopoietic stem cell transplantation: A systematic review and meta‐analysis

Increased risk of cardio-cerebrovascular disease after hematopoietic cell transplantation in patients with previous history

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