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

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.