Cardiac toxicity after allo-HCT

Acute myeloid leukemia (AML) is the most prevalent indication for allo-HCT, with an ongoing 10% annual increase in transplants performed worldwide. Post-transplant cyclophosphamide (PTCY), combined with other immunosuppressant agents, has become the standard GVHD prophylaxis for haploidentical-HCT, and secondary to its efficacy, its use is being expanded to matched sibling donor (MSD), 10/10 HLA-matched unrelated (MUD) and 9/10 HLA matched unrelated donor (MMUD) allo-HCT, with notable success. Cyclophosphamide (CY) is an alkylating agent of the nitrogen mustard class used to treat different malignant diseases and autoimmune disorders, and it is included as part of the preparative regimens in allo-HCT (7). In the setting of allo-HCT, Cy-based conditioning regimens have been associated with rates of cardiac toxicity that range from 1% to 17%. However, limited studies have investigated how PTCY interacts with the risk of cardiac toxicity. AML is the most prevalent indication for allo-HCT, and most induction treatments contain chemotherapy agents known to induce cardiac toxicity. Moreover, using PTCy-based GVHD prophylaxis is becoming more widespread in the transplant community. For these reasons, the present study will investigate the incidence and predictors for early and late cardiac events after allo-HCT performed in patients with AML, with particular attention to the effect of PTCY on the probability of presenting this complication.