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Incidence and predictors of severe cardiotoxicity in patients with severe aplastic anaemia after haploidentical haematopoietic stem cell transplantation

Bone Marrow Transplantation volume 54, pages 1694–1700 (2019)Cite this article

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Abstract

The aim of this study was to evaluate the frequency of severe cardiac complications and to assess the ability of various factors to predict these complications in severe aplastic anaemia (SAA) patients after haploidentical transplantation. A retrospective study was conducted in 216 consecutive SAA patients who underwent haploidentical transplantation from 2006 to 2017. All patients received a unified regimen including busulfan, cyclophosphamide (CTX) and antithymocyte globulin at a single centre. A total of 12 (5.6%) patients developed grade III or IV cardiac toxicity. Patients with cardiotoxicity had significantly poorer overall survival (OS) than did those without cardiotoxicity (12.5 vs. 89.6%, P < 0.001). A multivariable model identified four independent adverse predictors of severe cardiotoxicity: pre-transplant ECOG score ( ≥ 2), abnormal ST-T wave on 12-lead ECG, hyperlipaemia and recalculated CTX dose ( ≥ 1.8 g/m2/d). The incidences of severe cardiotoxicity were 50.0%, 6.0% and 1.3% in the high- (3–4 factors), intermediate- (2 factors) and low-risk (0–1 factor) groups, respectively (P < 0.001). The corresponding OS rates were 49.0%, 80.4% and 90.3%, respectively (P < 0.001), at final follow-up. Therefore, patients with high-risk scores had the poorest outcomes and should be monitored closely. Reduced intensity conditioning might be recommended for these patients.

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Acknowledgements

This work was partly supported by the National Natural Science Foundation of China (Grant Numbers 81670166, 81530046 and 81670167) and the Innovative Research Groups of the National Natural Science Foundation of China (Number 81621001). We thank all colleagues for participating in this research.

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  1. These authors contributed equally: Zheng-Li Xu, Lan-Ping Xu

Authors and Affiliations

  1. Peking University People’s Hospital, Peking University Institute of Hematology, Beijing, China

    Zheng-Li Xu, Lan-Ping Xu, Yuan-Yuan Zhang, Yi-Fei Cheng, Xiao-Dong Mo, Feng-Rong Wang, Yu-Hong Chen, Wei Han, Chen-Hua Yan, Yu-Qian Sun, Ting-Ting Han, Yu Wang, Xiao-Hui Zhang & Xiao-Jun Huang

  2. Peking-Tsinghua Center for Life Sciences, Beijing, China

    Xiao-Jun Huang

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Xu, ZL., Xu, LP., Zhang, YY. et al. Incidence and predictors of severe cardiotoxicity in patients with severe aplastic anaemia after haploidentical haematopoietic stem cell transplantation. Bone Marrow Transplant 54, 1694–1700 (2019). https://doi.org/10.1038/s41409-019-0509-1

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