Outcome of Allogeneic Hematopoietic Stem Cell Transplantation in Patients with Low Left Ventricular Ejection Fraction

Abstract

A high risk of regimen-related toxicity with allogeneic hematopoietic stem cell transplantation (allo-HSCT) limits this potentially curative treatment for patients with a left ventricular ejection fraction (LVEF) of ≥50%. We evaluated the frequency of cardiac complications and 100-day nonrelapse mortality (NRM) in 56 patients with a LVEF of ≤45%, who received allo HCTat our institution. The results were retrospectively compared with a matched control group with LVEF of ≥50%, which received an allogeneic stem cell transplantation (allo-SCT). After a median follow-up of 29 months in the study group, grade ≥2 cardiac complications were seen in 7 of 56 (12.5%) patients and cumulative incidence of 100-day NRM was 12.5% with no deaths from cardiac causes. In contrast, after a median follow-up of 49 months in the control group, grade >2 cardiac complications were seen in 19 of 161 patients (11.8%; P = 1.00) and cumulative incidence of 100-day NRM was 14.9% (P =.82). The presence of at least 1 of the 7 pretransplant cardiac risk factors (past history of smoking, hypertension, hyperlipidemia, coronary artery disease, arrhythmia, prior myocardial infarction, and congestive heart failure) was associated with a higher cardiac complication rate in the study group (P = .03). In conclusion, selected patients with a LVEF of ≤45% can safely receive allo-HCT without a significant increase in cardiac toxicity or NRM.

Hematopoietic Stem Cell Transplantation in Patients with Systolic Dysfunction: Can It Be Done?

“…Prior studies on the significance of a reduced LVEF in patients undergoing HCT are conflicting, with 4 reports that suggesting a reduced LVEF is a risk for serious cardiac complication [6,7,14-19]. We focused on the association of impaired LVEF and TRM.…”

“…The relative infrequency of major cardiac complications attributable to HCT, occurring in < 1% of transplantations at our institution, suggests that patients with impaired cardiac function are not predisposed to worse transplantation outcomes [5]. Qazilbash et al showed that patients with reduced left ventricular ejection fraction (LVEF) can safely undergo allogeneic HCT [6]. We investigated whether patients with systolic dysfunction are able to tolerate transplantation.…”

Comorbidities and Hematopoietic Cell Transplantation Outcomes

“…63 A study from MDACC found increased incidence of post-HCT cardiac toxicities if patients had one of seven preceding cardiac comorbidities. 64 Clearly, additional investigations are required to better predict and prevent organ toxicity based on preexisting multiple comorbidities.…”

Clinical impact of pre-transplant diastolic function on outcome after allogeneic hematopoietic SCT

“…3 In addition, we could not perform multivariate analysis for the cardiac event in the early phase of HSCT because of fewer events. However, the statistical significance of our results suggests that a high E/e′ value negatively affects the post-transplant course, and in contrast to EF, 10 the E/e′ value before HSCT may be a noninvasive, useful predictor of early cardiac complications, NRM and survival after HSCT.…”