title: Characteristics and survival of patients with chemotherapy-induced cardiomyopathy undergoing heart transplantation.
abstract: BACKGROUND
  New anti-neoplastic drugs have improved survival of cancer patients but have also been associated with chemotherapy-induced cardiomyopathy (CCMP), ultimately requiring orthotopic heart transplantation (OHT). We conducted this study to describe the clinical characteristics and outcomes of patients with CCMP treated with OHT and compare them with outcomes of patients with other forms of non-ischemic cardiomyopathy (NICMP).
  
  
  METHODS
  We retrospectively identified 232 CCMP patients and 8,890 NICMP patients from the International Society of Heart and Lung Transplantation Registry who underwent OHT between January 2000 and December 2008. Survival rates were calculated using the Kaplan-Meier method. Categoric characteristics and outcomes groups were compared using the χ(2) and Fisher exact test. Comparisons for continuous variables were made using Wilcoxon-Mann-Whitney test. Multivariable analyses of predictors of survival were performed using Cox proportional hazard regression analysis.
  
  
  RESULTS
  Short-term and long-term post-transplant survival of the 232 CCMP patients was similar to the 8,890 NICMP patients (p = 0.19). Survival (95% confidence interval) at 1, 3, and 5 years was, respectively, 86% (0.81-0.91), 79% (0.76-0.87), and 71% 0.73-0.85) in the CCMP patients and 87% (0.86-0.88), 81% (0.82-0.84), and 74% (0.80-0.81) in the NICMP patients (p = 0.19). Compared with NICMP patients, CCMP patients had higher rates of post-OHT infection (22% vs 14%, p = 004) and malignancies (5% vs 2%, p = 0.006), but neither affected survival. There was only 1 malignancy recurrence in the CCMP patients and no differences in post-OHT death due to malignancies between the groups. Importantly, CCMP patients were twice as likely as NICMP patients to require right ventricular assist devices before OHT (5.6% vs 2.3%, p = 0.0021).
  
  
  CONCLUSIONS
  Patients with CCMP selected for OHT are younger, have less comorbidity, and are more likely to require biventricular mechanical support pre-OHT than other NICMP patients who receive allografts. Despite the higher incidence of malignancy and infection in CCMP patients who have received a heart transplant, their survival is comparable to those who receive allografts for other cardiomyopathies.
authors.affiliation: Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Ave., Cleveland, OH 44195, USA. oliveig@ccf.org
authors.forename: Guilherme H
authors.initials: GH
authors.lastname: Oliveira
authors.forename: Brian W
authors.initials: BW
authors.lastname: Hardaway
authors.forename: Anna Y
authors.initials: AY
authors.lastname: Kucheryavaya
authors.forename: Josef
authors.initials: J
authors.lastname: Stehlik
authors.forename: Leah B
authors.initials: LB
authors.lastname: Edwards
authors.forename: David O
authors.initials: DO
authors.lastname: Taylor
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000970:Antineoplastic Agents / Q000009:adverse effects*; D009202:Cardiomyopathies / Q000139:chemically induced* / Q000601:surgery* / Q000628:therapy; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D016027:Heart Transplantation / Q000401:mortality*; D006353:Heart-Assist Devices; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012042:Registries; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents