Department of Haematology, Oncology and Cardiovascular Medicine, Kyushu University Hospital, Fukuoka, Japan.
Department of Haematology, Oncology and Cardiovascular Medicine, Kyushu University Hospital, Fukuoka, Japan
Open Heart. 2022 May;9(1). doi: 10.1136/openhrt-2022-002007.
Heart failure following allogeneic haematopoietic stem cell transplantation (allo-HSCT) is a serious complication that requires early detection; however, the clinical implications of early-onset cancer therapy-related cardiac dysfunction (CTRCD) following allo-HSCT remain unclear. We investigated the determinants and prognostic impact of early-onset CTRCD in allo-HSCT recipients.
The records of 136 patients with haematological malignancies who underwent allo-HSCT at our institute were retrospectively reviewed. Early-onset CTRCD was defined as a decrease in left ventricular ejection fraction (LVEF) of ≥10% and an LVEF of ≤53% within 100 days after HSCT.
Early-onset CTRCD was diagnosed in 23 out of 136 included patients (17%), and the median duration from HSCT to CTRCD diagnosis was 24 (9-35) days. Patients were followed up for 347 (132-1268) days. In multivariate logistic regression analysis, cumulative doxorubicin dosage (each 10 mg/m) and severity of acute graft-versus-host disease (GVHD/grade) were independent indicators of early-onset CTRCD (OR (95% CI) 1.04 (1.00 to 1.07); p=0.032; OR (95% CI) 1.87 (1.19 to 2.95), p=0.004, respectively). The overall and primary disease death rates were significantly higher in allo-HSCT recipients with early-onset CTRCD than in those without early-onset CTRCD (HR (95% CI) 1.98 (1.11 to 3.52), p=0.016; HR (95% CI) 2.96 (1.40 to 6.29), p=0.005, respectively), independent of primary disease type, remission status and transplantation type.
Severe acute GVHD and higher cumulative anthracycline are two significant determinants of early-onset CTRCD. Early-onset CTRCD following allo-HSCT regulates survival in patients with haematological malignancies.
异基因造血干细胞移植（allo-HSCT）后心力衰竭是一种严重的并发症，需要早期发现；然而，allo-HSCT 后早期发生的与癌症治疗相关的心脏功能障碍（CTRCD）的临床意义仍不清楚。我们研究了 allo-HSCT 受者中早期发生的 CTRCD 的决定因素及其预后影响。
回顾性分析了在我院接受 allo-HSCT 的 136 例血液恶性肿瘤患者的病历。早期发生的 CTRCD 定义为 HSCT 后 100 天内左心室射血分数（LVEF）下降≥10%且 LVEF≤53%。
在 136 例纳入患者中，23 例（17%）诊断为早期发生的 CTRCD，从 HSCT 到 CTRCD 诊断的中位时间为 24（9-35）天。患者接受了 347（132-1268）天的随访。在多变量逻辑回归分析中，累积阿霉素剂量（每 10mg/m）和急性移植物抗宿主病（GVHD/分级）的严重程度是早期发生的 CTRCD 的独立指标（OR（95%CI）1.04（1.00 至 1.07）；p=0.032；OR（95%CI）1.87（1.19 至 2.95），p=0.004）。与无早期发生的 CTRCD 的 allo-HSCT 受者相比，早期发生的 CTRCD 的 allo-HSCT 受者的总死亡率和主要疾病死亡率均显著升高（HR（95%CI）1.98（1.11 至 3.52），p=0.016；HR（95%CI）2.96（1.40 至 6.29），p=0.005），独立于主要疾病类型、缓解状态和移植类型。
严重的急性 GVHD 和较高的累积蒽环类药物是早期发生的 CTRCD 的两个重要决定因素。allo-HSCT 后早期发生的 CTRCD 调节血液恶性肿瘤患者的生存。
