Hematology Department, Hospital Clínic de Barcelona, Barcelona, Spain.
Cardiology Department at Hospital Clinic de Barcelona, Barcelona, Spain.
Blood Adv. 2024 Nov 12;8(21):5497-5509. doi: 10.1182/bloodadvances.2024013535.
This multicenter study sponsored by the GETH-TC investigates the incidence and predictors of early (first 100 days) and late cardiac events (CEs; ECEs and LCEs, respectively) after allo-HCT in patients with acute myeloid leukemia (AML) treated with anthracyclines, focusing on exploring the impact of PTCY on cardiac complications and the impact of CEs on OS and NRM. A total of 1020 patients with AML were included. PTCY was given to 450 (44.1%) adults. Overall, 94 (9.2) patients experienced CEs, with arrythmias, pericardial complications, and heart failure the most prevalent. ECEs occurred in 49 (4.8%) patients within a median of 13 days after allo-HCT, whereas LCEs were diagnosed in 45 (4.4%) patients within a median of 3.6 years after transplant. Using PTCY increased the risk for ECEs in multivariate analysis (hazard ratio [HR], 2.86; P = .007) but did not significantly affect the risk for LCEs (HR, 1.06; P = .892). The impact of variables on outcomes revealed was investigated using multivariate regression analyses and revealed that the diagnosis of CEs decreased the likelihood of OS (HR, 1.66; P = .005) and increased the likelihood of NRM (HR, 2.88; P < .001). Furthermore, despite using PTCY increased ECEs risk, its administration was beneficial for OS (HR, 0.71; P = .026). In conclusion, although the incidence of CEs was relatively low, it significantly affected mortality. Standard doses of PTCY increased ECE risk but were associated with improved OS. Therefore, protocols for preventing cardiac complications among these patients are needed.
这项由 GETH-TC 赞助的多中心研究调查了接受蒽环类药物治疗的急性髓系白血病(AML)患者在异基因造血细胞移植(allo-HCT)后早期(前 100 天)和晚期心脏事件(CEs;ECEs 和 LCEs)的发生率和预测因素,重点探讨了 PTCY 对心脏并发症的影响以及 CEs 对 OS 和 NRM 的影响。共纳入 1020 例 AML 患者。450 例(44.1%)成人接受 PTCY 治疗。总体而言,94 例(9.2%)患者发生 CEs,心律失常、心包并发症和心力衰竭最为常见。ECEs 发生在 allo-HCT 后中位时间为 13 天内的 49 例(4.8%)患者中,而 LCEs 发生在移植后中位时间 3.6 年内的 45 例(4.4%)患者中。多变量分析显示,使用 PTCY 增加了 ECEs 的风险(危险比[HR],2.86;P=0.007),但对 LCEs 的风险没有显著影响(HR,1.06;P=0.892)。使用多变量回归分析探讨了变量对结局的影响,结果表明 CEs 的诊断降低了 OS 的可能性(HR,1.66;P=0.005),并增加了 NRM 的可能性(HR,2.88;P<0.001)。此外,尽管使用 PTCY 增加了 ECEs 的风险,但它对 OS 有益(HR,0.71;P=0.026)。总之,尽管 CEs 的发生率相对较低,但它显著影响了死亡率。标准剂量的 PTCY 增加了 ECE 风险,但与 OS 改善相关。因此,需要为这些患者制定预防心脏并发症的方案。