title: Outcome of allogeneic hematopoietic stem cell transplantation in patients with low left ventricular ejection fraction.
abstract: A high risk of regimen-related toxicity with allogeneic hematopoietic stem cell transplantation (allo-HSCT) limits this potentially curative treatment for patients with a left ventricular ejection fraction (LVEF) of > or =50%. We evaluated the frequency of cardiac complications and 100-day nonrelapse mortality (NRM) in 56 patients with a LVEF of < or =45%, who received allo HCT at our institution. The results were retrospectively compared with a matched control group with LVEF of > or =50%, which received an allogeneic stem cell transplantation (allo-SCT). After a median follow-up of 29 months in the study group, grade > or =2 cardiac complications were seen in 7 of 56 (12.5%) patients and cumulative incidence of 100-day NRM was 12.5% with no deaths from cardiac causes. In contrast, after a median follow-up of 49 months in the control group, grade >2 cardiac complications were seen in 19 of 161 patients (11.8%; P = 1.00) and cumulative incidence of 100-day NRM was 14.9% (P = .82). The presence of at least 1 of the 7 pretransplant cardiac risk factors (past history of smoking, hypertension, hyperlipidemia, coronary artery disease, arrhythmia, prior myocardial infarction, and congestive heart failure) was associated with a higher cardiac complication rate in the study group (P = .03). In conclusion, selected patients with a LVEF of < or =45% can safely receive allo-HCT without a significant increase in cardiac toxicity or NRM.
authors.affiliation: Stem Cell Transplantation and Cellular Therapy, University of Texas M.D. Anderson Cancer Center, Houston, Texas 77030, USA. mqazilba@mdanderson.org
authors.forename: Muzaffar H
authors.initials: MH
authors.lastname: Qazilbash
authors.forename: Ali Imran
authors.initials: AI
authors.lastname: Amjad
authors.forename: Suhail
authors.initials: S
authors.lastname: Qureshi
authors.forename: Sofia R
authors.initials: SR
authors.lastname: Qureshi
authors.forename: Rima M
authors.initials: RM
authors.lastname: Saliba
authors.forename: Ziad U
authors.initials: ZU
authors.lastname: Khan
authors.forename: Chitra
authors.initials: C
authors.lastname: Hosing
authors.forename: Sergio A
authors.initials: SA
authors.lastname: Giralt
authors.forename: Marcos J
authors.initials: MJ
authors.lastname: De Lima
authors.forename: Uday R
authors.initials: UR
authors.lastname: Popat
authors.forename: Syed W
authors.initials: SW
authors.lastname: Yusuf
authors.forename: Richard E
authors.initials: RE
authors.lastname: Champlin
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006331:Heart Diseases / Q000209:etiology / Q000401:mortality*; D019337:Hematologic Neoplasms / Q000401:mortality / Q000628:therapy; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D012595:Scleroderma, Systemic / Q000401:mortality / Q000628:therapy; D013318:Stroke Volume; D015996:Survival Rate; D013997:Time Factors; D014184:Transplantation, Homologous