Impact of cardiovascular complications on survival following hematopoietic stem cell transplantation
F Guerra, V Cetoretta, F Saraceni, A Frangione, E Rrapaj, G Mancini, A Fazeli, A Cipiciani, A Dello Russo, A PoloniAbstract
Background
Hematopoietic stem cell transplantation (HSCT) serves as a first-line intervention for various hematologic malignancies. While advancements in safety have expanded eligibility to older patients and those with pre-existing comorbidities, cardiovascular (CV) adverse vents represent a notable source of morbidity and mortality. This registry sought to quantify the incidence of these CV complications and evaluate their specific impact on survival in the post-transplant period.
Methods
This regional observational cohort study consecutively enrolled adult patients undergoing autologous or allogeneic HSCT between 2019 and 2025. Participants underwent a dedicated screening protocol involving 12-lead ECGs, echocardiography, and cardiac biomarker assessment at baseline, 2, 6, and every six months post-transplant. The primary outcomes of interest included new-onset systolic dysfunction, thromboembolic events (VTE and PE), stroke, arrhythmias, pericarditis, and hypertensive crises.
Results
The study followed 145 patients with a mean age of 55±13 years for a median of 2.6 years (1.1-5.1 years). Although the prevalence of major CV risk factors was initially low, with only 17% of patients having a prior CV event, 39% of the cohort experienced at least one CV-related adverse event during the follow-up period. Specifically, clinicians identified 12 VTE/PE, 8 atrial fibrillation, 7 heart failure/cardiogenic shock, 5 peripheral vascular disease and 5 hypertensive crises (Figure 1). A significant majority of these events (68%) occurred within the first six months. Experiencing any kind of CV adverse event was associated with a more than twofold increase in all-cause mortality, rising from 12% to 29% (Figure 2; p=.003).
Conclusions
Cardiovascular complications are prevalent among HSCT recipients and can impact even relatively young and healthy individuals. The occurrence of a CV event is a powerful negative prognostic indicator for overall survival, and most of them occur within the first six months.Cardiovascular adverse events Overall survival according to CV events