Cyclophosphamide‐induced cardiotoxicity at conditioning for allogeneic hematopoietic stem cell transplantation would occur among the patients treated with 120 mg/kg or less

• Published in: Asia-Pacific journal of clinical oncology 2022-10, Vol.18 (5), p.e507-e514
• Main Authors: Marumo, Atsushi, Omori, Ikuko, Tara, Shuhei, Otsuka, Yuki, Konuma, Ryosuke, Adachi, Hiroto, Wada, Atsushi, Kishida, Yuya, Konishi, Tatsuya, Nagata, Akihito, Yamada, Yuta, Nagata, Ryohei, Noguchi, Yuma, Toya, Takashi, Igarashi, Aiko, Najima, Yuho, Kobayashi, Takeshi, Yamaguchi, Hiroki, Inokuchi, Koiti, Sakamaki, Hisashi, Ohashi, Kazuteru, Doki, Noriko
• Format: Article
• Language: English
• Subjects: allogeneic hematopoietic stem cell transplantation (allo‐HSCT); Aplastic anemia; Cardiotoxicity; Congestive heart failure; Cyclophosphamide; cyclophosphamide (CY); haploidentical‐HSCT; Heart failure; Heart rate; Hematopoietic stem cells; intensive care unit (ICU); Patients; Risk factors; Stem cell transplantation; Stem cells; Transplants & implants
• ISSN: 1743-7555; 1743-7563
• DOI: 10.1111/ajco.13674

Cyclophosphamide (CY)‐induced cardiotoxicity involves rare lethal complications. We previously reported the cardiac events of 811 allogeneic hematopoietic stem cell transplant (allo‐HSCT) recipients; 12 out of 811 recipients (1.5%) developed fatal heart failure. The mortality rate was also very high (91.6%, 11/12). CY dose (200 mg/kg or more) was reported as the independent risk factor. The main disease in patients treated with 200 mg/kg or more of CY was severe aplastic anemia (AA). Therefore, we reduced the dose of CY during conditioning for AA (from 200 to 100 mg/kg), and then we analyzed the clinical features of 294 patients who received a total dose of at least 100 mg/kg of CY. We also compared the clinical features between the current study and our previous study. The proportion of patients treated with at least 200 mg/kg of CY was reduced from 4.2% to 0%. However, CY‐induced heart failure occurred in four of the 294 patients (1.4%), which was similar to the finding reported in our previous study (1.5%). Two of these four patients received a post‐transplant CY (PTCy) regimen (CY 100 mg/kg). All four patients were treated in the cardiac intensive care unit (C‐ICU), and two patients survived. In summary, even the CY dose of 120 mg/kg or less would cause cardiotoxicity. We should also carefully monitor patients treated with PTCy, considering the possibility of CY‐induced cardiotoxicity. Early diagnosis and ICU management have contributed to improved outcomes.