Incidence of Cardiovascular Events in Patients Receiving Hematopoietic Stem Cell Transplant (HSCT) in HCTM – (A Retrospective Cohort Study)

Abstract

Background: Hematopoietic stem cell transplantation (HSCT) offers curative potential for hematologic malignancies but carries risks of cardiovascular events (CE). Existing data are predominantly from Western populations, with limited evidence from Asian centers.
Objectives: To determine the incidence of short-term (<100 days) and long-term (1-year) cardiovascular events post-HSCT at Hospital Canselor Tuanku Muhriz (HCTM), and to identify associated risk factors, including the usage CARE-BMT score in risk stratification.
Methods: This retrospective cohort study included adult patients who underwent autologous or allogeneic HSCT from 2000 to 2024 at HCTM. Data collected via manual and electronic medical records which included demographics, comorbidities, transplant type, conditioning regimens, and cardiovascular outcomes (heart failure, arrhythmia, myocardial infarction, stroke, cardiac death). Statistical analysis comprises of descriptive and unadjusted univariate tests.
Results: A total of 117 patients were included (63 allogeneic, 54 autologous). The 1-year incidence of cardiovascular events (CE) was 5.1% (6/117), with a higher rate among allogeneic recipients (9.3%) compared to autologous (1.6%). Unadjusted odds ratio (OR) analysis revealed that allogeneic transplant was associated with a higher, albeit nonsignificant, risk of CE (OR 3.84, 95% CI 0.42–34.95). Other factors with elevated but non-significant ORs included obesity (OR 2.91, 95% CI 0.32–26.72), hypertension (OR 2.57, 95% CI 0.28–23.95), and CARE-BMT intermediate/high risk score versus low (OR 7.68, 95% CI 0.86–68.28). Reduced baseline left ventricular ejection fraction (<50%) showed the highest estimated risk (OR 64.7, 95% CI 3.2–1304.8), but with a very wide confidence interval due to limited events. Most events occurred within 100 days post-transplant, and 83% of CE cases had intermediate/high CARE-BMT scores. However, multivariate analysis was limited by the small number of events and wide confidence intervals.
Conclusions: The incidence of cardiovascular events post-HSCT in this Malaysian cohort was comparable to global data, with higher rates in allogeneic recipients and those with intermediate/high CARE-BMT scores. Most events occurred early post-transplant and in patients with traditional or transplant-specific risk factors. CARE-BMT score and baseline cardiac function may help stratify risk. Ongoing monitoring and tailored preventive strategies are necessary for this population. Future larger multi-center, prospective studies are required to confirm these trends and guide targeted cardio-oncology interventions for HSCT recipients in Malaysia.