Impact of Dimethyl Sulfoxide on Early Cardiotoxicity After Allogeneic Hematopoietic Stem Cell Transplantation.

UNLABELLED: During the COVID-19 pandemic, the use of cryopreserved grafts in allogeneic hematopoietic stem cell transplantation (HSCT) increased substantially. Dimethyl sulfoxide (DMSO), used as a cryoprotective agent, is well recognized for its infusion-related toxicity; however, its impact on cardiac function remains unclear.

METHODS

This prospective study included 96 consecutive patients (median age 46 years) undergoing allogeneic HSCT. Patients were divided according to graft type into cryopreserved (n = 59, 61.5%) and non-cryopreserved (n = 37, 38.5%) groups. Comprehensive echocardiographic assessment was performed before and after transplantation.

RESULTS

Significant changes were observed in diastolic parameters (E/A, and E/E'), structural parameters (left ventricular mass and left ventricular mass index), global longitudinal strain (GLS), and right ventricular ejection fraction following HSCT. In the cryopreserved group, E/A ratio decreased below the normal range and E/E' ratio increased significantly, whereas no such changes were observed in the non-cryopreserved group. During the 30-day follow-up period, symptomatic cardiovascular toxicity occurred in 5 patients (5.2%), while subclinical cancer therapy-related cardiac dysfunction was detected in 16 patients (16.7%). Receiver operating characteristic (ROC) analysis demonstrated that GLS predicted cardiotoxicity with an area under the curve (AUC) of 0.88 (95% CI, 0.79-0.98; p < 0.0001). At a cut-off value of - 16.8%, sensitivity was 100% and specificity was 79%.

CONCLUSION

Cryopreserved graft administration may be associated with early alterations in left ventricular diastolic function, potentially reflecting DMSO-related cardiotoxicity. GLS appears to be a sensitive marker for the early detection and prediction of cardiotoxicity in patients undergoing allogeneic HSCT.