Sanchez-Petitto Gabriela, Goloubeva Olga, Childress James, Iqbal Tahreem, Masur Jack, An Max, Muhammad Safwan, Lawson Justin, Li Grace, Barr Brian, Emadi Ashkan, Duong Vu H, Hardy Nancy M, Rapoport Aaron P, Baer Maria R, Niyongere Sandrine, Yared Jean A
Division of Hematology and Oncology, Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA.
Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA.
Acta Haematol. 2025;148(4):386-397. doi: 10.1159/000541131. Epub 2024 Aug 27.
INTRODUCTION/BACKGROUND: Reduced-intensity conditioning (RIC) and nonmyeloablative (NMA) regimens have enabled patients with cardiovascular disease (CVD) to undergo allogeneic stem cell transplantation (allo-HSCT). However, little is known about long-term outcomes, including cardiovascular (CV) complications.
We retrospectively studied 99 consecutive patients with acute myeloid leukemia (AML) or myelodysplastic syndrome (MDS) who underwent allo-HSCT between September 1, 2013, and November 30, 2020. Overall survival (OS), progression-free survival (PFS), nonrelapse mortality (NRM), cumulative incidence of relapse, and cumulative incidence of acute and chronic graft-versus-host disease (GvHD) were compared in patients with and without CV risk factors or disease.
Preexisting CVD was present in 34 of 99 patients (34%). CVD patients more commonly had reduced-intensity conditioning (91% vs. 60%, p = 0.001) and unrelated donors (56% vs. 35%, p = 0.04). Early adverse cardiac events occurred more frequently in the CVD versus no-CVD group (38% vs. 14%), particularly arrhythmias (21% vs. 5%; p = 0.04). CVD patients tended to have poorer OS and PFS outcomes (HR = 1.98, [1.00, 3.92]; HR = 1.89, [0.96-3.72], respectively). OS rate at 1, 2, and 3 years for CVD versus no-CVD patients was 66% versus 72%, 55% versus 64%, and 46% versus 62%, respectively. Causes of death in the CVD and no-CVD groups were infections (53% vs. 28%), relapsed disease (32% vs. 52%), and CV events (10% vs. 3%).
Based on these data, predictive models to identify patients with CVD with higher risk of post-allo-HSCT complications and mortality and strategies to mitigate these risks should be developed.
引言/背景：降低强度预处理（RIC）和非清髓性（NMA）方案使心血管疾病（CVD）患者能够接受异基因造血干细胞移植（allo-HSCT）。然而，对于包括心血管（CV）并发症在内的长期结局知之甚少。
我们回顾性研究了199例在2013年9月1日至2020年11月30日期间接受allo-HSCT的急性髓系白血病（AML）或骨髓增生异常综合征（MDS）患者。比较了有和没有CV危险因素或疾病的患者的总生存期（OS）、无进展生存期（PFS）、非复发死亡率（NRM）、复发累积发生率以及急慢性移植物抗宿主病（GvHD）的累积发生率。
99例患者中有34例（34%）存在既往CVD。CVD患者更常采用降低强度预处理（91%对60%，p = 0.001）且使用无关供者（56%对35%，p = 0.04）。与无CVD组相比，CVD组早期不良心脏事件更频繁发生（38%对14%），尤其是心律失常（21%对5%；p = 0.04）。CVD患者的OS和PFS结局往往较差（HR分别为1.98，[1.00, 3.92]；HR为1.89，[0.96 - 3.72]）。CVD患者与无CVD患者1年、2年和3年的OS率分别为66%对72%、55%对64%和46%对62%。CVD组和无CVD组的死亡原因分别为感染（53%对28%）、疾病复发（32%对52%）和CV事件（10%对3%）。
基于这些数据，应开发预测模型以识别allo-HSCT后并发症和死亡率风险较高的CVD患者，并制定减轻这些风险的策略。
