Supplementary Material for: Outcomes of Patients with Myeloid Malignancies and Cardiovascular Disease Undergoing Allogeneic Stem Cell Transplantation

Introduction/Background: Reduced-intensity conditioning (RIC) and non-myeloablative (NMA) regimens have enabled patients with cardiovascular disease (CVD) to undergo allogeneic stem cell transplantation (allo-HSCT). However, little is known about long-term outcomes, including cardiovascular (CV) complications.

Methods: We retrospectively studied 99 consecutive patients with acute myeloid leukemia (AML) or myelodysplastic syndrome (MDS) who underwent allo-HSCT between September 1, 2013, and November 30, 2020. Overall survival (OS), progression-free survival (PFS), non-relapse mortality (NRM), cumulative incidence of relapse and cumulative incidence of acute and chronic graft-versus host disease (GvHD) were compared in patients with and without CV risk factors or disease.

Results: Preexisting CVD was present in 34 of 99 patients (34%). CVD patients more commonly had reduced-intensity conditioning (91% vs 60%, p=0.001) and unrelated donors (56% vs 35%, p=0.04). Early adverse cardiac events occurred more frequently in the CVD vs. no-CVD group (38% vs 14%), particularly arrhythmias (21% vs 5%; p= 0.04). CVD patients tended to have poorer OS and PFS outcomes [HR=1.98, (1.00, 3.92); HR= 1.89, (0.96-3.72), respectively]. OS rate at 1, 2 and 3 years for CVD vs. no-CVD patients was 66% vs. 72%, 55% vs. 64%, and 46% vs. 62% respectively. Causes of death in the CVD and no-CVD groups were infections (53% vs 28%), relapsed disease (32% vs 52%), and CV events (10% vs 3%).

Conclusion: Based on these data, predictive models to identify patients with CVD with higher risk of post-alloSCT complications and mortality and strategies to mitigate these risks should be developed.