Myocardial Dysfunction in Autologous Hematopoietic Stem Cell Transplantation: Challenges in Prediction Pavlov University

Introduction. Cyclophosphamide-induced cardiotoxicity is one of the most severe complications of high-dose immunosuppressive therapy followed by autologous hematopoietic stem cell transplantation (HDIT-AHSCT). The early onset of myocardial dysfunction (within 2–10 days) limits the effectiveness of current monitoring strategies and necessitates the development of early prediction methods.

Objective. To develop predictive models for early identification of patients at high risk of myocardial dysfunction during autologous HDIT-AHSCT.

Materials and Methods. This observational cohort study included 74 patients with multiple sclerosis (mean age 36±8 years) undergoing autologous HDIT-AHSCT with high-dose cyclophosphamide. Assessments were performed before treatment and on days 3 and 7 of therapy. Cardiac biomarkers, electrocardiographic, and echocardiographic parameters were evaluated. Stepwise discriminant analysis was used to develop predictive models.

Results. Subclinical cardiotoxicity (NT-proBNP ≥534 pg/mL) was detected in 65 % of patients, while clinically manifest cardiotoxicity occurred in 5 %. A predictive model for subclinical myocardial dysfunction was developed, incorporating diastolic function parameters (E/A, ΔE/A, ΔE), left atrial volume, and hemoglobin level (sensitivity 96.8 %, accuracy 88.1 %). A model for predicting acute left ventricular heart failure was based on E/e’, serum urea levels, and changes in left ventricular mass (overall accuracy 97.3 %). Key alterations were detectable as early as day 3 of therapy.

Conclusion. The proposed models enable early identification of patients at high risk of cardiotoxicity during autologous HDIT-AHSCT. This provides an opportunity for timely treatment modification and prevention of severe cardiovascular complications.

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