Association between B-type natriuretic peptide levels after the first dose of cyclophosphamide and early cardiac events and transplantation outcomes

Abstract

Abstract Posttransplant cyclophosphamide (PTCy) has proven to be an effective approach for preventing graft-versus-host disease (GVHD) after haploidentical HSCT. However, PTCy is associated with toxicities. It has been reported to be associated with a higher incidence of early cardiac events (ECEs) occurring during the first 100 days after HSCT. We performed a retrospective study including patients (187 patients) who underwent haploidentical peripheral stem cell transplantation between January 1, 2013, and October 13, 2022 in our institute. All patients received post-transplant cyclophosphamide (PTCY) as part of Graft versus Host disease prophylaxis. We investigated the association between N-terminal pro-B-type natriuretic peptide (BNP) levels and ECEs after PTCy. The study found that elevated BNP levels (> 530 pg/ml) on day 4 after the first dose of PTCy were significantly correlated with ECEs (3-month cumulative incidence: 54% vs. 4.5%). Patients with high BNP levels also had a higher risk of non-relapse mortality (NRM) and worse overall survival (OS) (3-year NRM: high BNP levels vs. low BNP levels: 66% vs. 28%, p = 0.001; 3-year OS: high BNP levels vs. low BNP levels: 12% vs. 38%, p = 0.011 ). These findings suggest that BNP levels may be a useful biomarker for predicting PTCy-induced cardiotoxicity in HSCT patients.