Short-term cardiotoxicity and early echocardiographic changes following autologous hematopoietic stem cell transplantation: a single-center retrospective analysis.

BACKGROUND

Autologous stem cell transplantation (ASCT) is a potentially curative treatment for several hematologic malignancies. However, the short-term cardiotoxic effects of conditioning regimens remain underexplored. This study evaluates echocardiographic changes occurring within the first 100 days after ASCT.

METHODS

We conducted a retrospective single-center study of 205 lymphoma and Multiple Myeloma patients who underwent ASCT at the American University of Beirut Medical Center (AUBMC) between 2013 and 2022. Echocardiographic parameters before ASCT were compared to those obtained 100 days post-transplant. Conditioning regimens for the lymphoma patients included BEAM (carmustine, etoposide, cytarabine, and melphalan), however for the Multiple Myeloma patients, high-dose melphalan (200 mg/m2), and other chemotherapy-based regimens. Primary outcomes were changes in left ventricular ejection fraction (LVEF) and the incident of new valvular disease. Statistical analyses included paired t-tests, McNemar's test, and chi-square tests.

RESULTS

Among 205 patients, 97 (47.3%) had partial remission at transplantation, and 176 (85.9%) had no prior left ventricular (LV) dysfunction. A total of 108 (52.7%) received myeloablative BEAM conditioning. Pre-ASCT, 193 (94.1%) patients had LVEF >50%, compared with 187 (91.2%) at 100 days post-ASCT (p = 0.286). The mean LVEF showed a modest but statistically significant decline (p = 0.016). The prevalence of valvular abnormalities increased from 86 (42%) to 104 (50.7%) post-ASCT (p = 0.073). Pre-existing LV dysfunction was significantly associated with both post-transplant LV dysfunction and valvular disease (p = 0.018 and p < 0.05, respectively). Male gender was associated with a higher incidence of valvular disease (p = 0.024). Conditioning intensity, malignancy type, and prior valvular disease were not significantly correlated with cardiac outcomes. Interestingly, 12 patients with baseline LVEF <50% experienced no cardiac events or ICU admissions post-ASCT; 9 of these demonstrated improved LVEF at follow-up.

CONCLUSIONS

ASCT is associated with mild but statistically significant early declines in LVEF and increased valvular abnormalities within 100 days post-transplant. Early post-ASCT echocardiographic surveillance may enable the detection of subclinical cardiotoxicity. Prospective longitudinal studies are warranted to define the long-term cardiac impact of ASCT and its conditioning regimens.