Late cardiac events and their impact on overall survival in patients receiving an allogeneic stem cell transplant.

12070 Background: There is limited data on the impact of cardiac disease on long term outcomes of allogeneic stem cell transplant (alloSCT). We sought to describe the importance of adverse cardiac events on long term outcomes of alloSCT. Methods: We performed a retrospective analysis of pts who underwent alloSCT from 2007 to 2017 and survived at least one year after transplantation. Late cardiac events were defined as occurring at least one year after transplant. Data was obtained through electronic medical records and the transplant database at Siteman Cancer Center. Univariate Cox proportional hazards model was used to assess the effect of baseline characteristics on cardiac events and overall survival. Time-dependent Cox model was used to determine the effect of cardiac events on overall survival. Gray’s sub-distribution methods, while accounting for death as a competing risk, were used to calculate the incidence of cardiac events. Results: 804 pts met our criteria (58.7% male, average age 49.7 years). Median duration of follow up was 59.3 months. Most pts were transplanted for acute myeloid leukemia (49.9%) and had a match-related or unrelated donor (56.1%). The majority received myeloablative conditioning (74.4%), and 34.6% received total body irradiation (TBI). The most common late cardiac events were an elevated troponin (20.9%), elevated brain natriuretic peptide (BNP) or N-terminal pro-BNP (16.9%), shock (15.3%), and reduced left ventricular ejection fraction (LVEF) defined as < 45% (10.4%). Pts were at significantly increased hazard of developing late cardiac events if they were of male sex (HR 1.29, P = 0.026), had pre-existing diabetes (HR 1.45, P = 0.022), pre-existing atrial fibrillation or flutter (HR 1.77, P = 0.008), history of congestive heart failure (HR 1.82, P = 0.032) or increasing age at time of transplant (HR 1.02, P < 0.001). Primary disease for alloSCT, donor type, TBI and myeloablative conditioning regimen had no significant association with late cardiac events. The cumulative incidence of developing any cardiac event in the period 1-5 years after transplant was 28.2% with a cumulative incidence of shock at 13.6%, reduced ejection fraction at 8.7% and an atrial arrythmia at 7.1%. Most cardiac events were associated with an increased risk of death (Table). Conclusions: Cardiac events after alloSCT have a substantial impact on overall survival. Efforts to optimally manage cardiac disease after alloSCT are likely to have a major benefit, and cardiac protection should be a major focus for post-alloSCT follow up.[Table: see text]