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December 2, 2022
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Article

Incidence, Risk Factors, and Impact of Early Cardiac Toxicity after Allogeneic Hematopoietic Cell Transplantation

Publicated to:Blood Advances. 7 (10): 2018-2031 - 2023-05-23 7(10), DOI: 10.1182/bloodadvances.2022008792

Authors: Pérez-Valencia, AI; Cascos, E; Carbonell-Ordeig, S; Charry, P; Gómez-Hernando, M; Rodríguez-Lobato, LG; Suárez-Lledó, M; Martínez-Cibrian, N; Antelo, MG; Solano, MT; Arcarons, J; Nomdedeu, M; Cid, J; Lozano, M; Díaz-Ricart, M; Rosiñol, L; Esteve, J; Urbano-Ispizua, A; Carreras, E; Martínez, C; Fernández-Avilés, F; Rovira, M; Salas, MQ

Affiliations

5.07.02 - Neoplàsies limfoides. Institut d'Investigacions Biomèdiques August Pi i Sunyer - Author
Clinic Barcelona, Barcelona, Spain. - Author
Department of Hematology and Oncology, Barcelona, Spain. - Author
Hosp Clin Barcelona, Clin Inst Hematol & Oncol, Hematol Dept, Hematopoiet Cell Transplant Unit, Barcelona, Spain - Author
Hosp Clin Barcelona, Clin Inst Hematol & Oncol, Hemotherapy & Hemostasis Dept, Apheresis & Cellular Therapy Unit, Barcelona, Spain - Author
Hosp Clin Barcelona, Dept Cardiol, Barcelona, Spain - Author
Hosp Clin Barcelona, Dept Radiat Oncol, Barcelona, Spain - Author
Hosp Clin Barcelona, Hematopathol Pathol Dept, CDB, Barcelona, Spain - Author
Hospital Clinic Barcelona, Barcelona, Spain. - Author
Hospital Clinic de Barcelona, Barcelona, Spain. - Author
Hospital Clinic of Barcelona, Barcelona, Spain. - Author
Hospital Clinic, Barcelona, Spain. - Author
Inst Invest Biomed August Pi i Sunyer, Barcelona, Spain - Author
Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Spain. - Author
Josep Carreras Inst Leukemia, Campus Clin, Barcelona, Spain - Author
Univ Barcelona, Hematol Dept, Barcelona, Spain - Author
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Abstract

This study investigates early cardiac events (ECE) occurring during the first 180 days after allo-HCT in 416 adults receiving PTCY (n=258) and non-receiving PTCY (n=158). Total body irradiation (TBI) was given to 133 (31.9%) patients, in 111 (83.4%) of them combined with PTCY. The day +180 cumulative incidence function (CIF) of ECE was 8.4%, being heart failure (n=13) and pericardial complications (n=11) as the most prevalent complications. The incidence of ECE was higher in patients receiving PTCY (Day +180 CIF: 11.3% vs. 3.8%, P=0.007), and receiving TBI (Day +180 CIF: 15.0% vs. 5.3%, P<0.001). ECEs were more prevalent in haplo-HCTs than in MSD, MUD, and MMUDs allo-HCTs (Day +180 CIF of 17.9%, 6.2%, 8.4% and 7.4%, P=0.005). As for the ECE's risks from the combination of PTCY and TBI, the multivariate analysis reported that patients receiving PTCY without TBI (HR 3.79, P=0.041), those receiving TBI without PTCY (HR 6.01, P=0.027), and patients receiving TBI and PTCY (HR 6.98, P=0.002) were at higher risk for ECE compared with patients receiving neither PTCY nor TBI. Pre-existing cardiac morbidity predicted ECE (HR 5.28, P<0.001). However, using high-dose Cy-containing preparative regimens did not increase the risk for cardiac toxicity at +180 days after allo-HCT (HR 0.58, P=0.53). ECE was associated with higher NRM (HR 4.68, P<0.001) and lower OS (HR 3.03, P<0.001). Considering that PTCY and TBI were predictors for ECE, and the impact of this complication on transplant mortality, the implementation of cardiac monitoring plans could be appropriate in patients receiving these medications.Copyright © 2022 American Society of Hematology.

Keywords

AdultCardiotoxicityCyclophosphamideHematopoietic stem cell transplantationHumansIncidenceRisk factorsUnrelated donors

Quality index

Bibliometric impact. Analysis of the contribution and dissemination channel

The work has been published in the journal Blood Advances due to its progression and the good impact it has achieved in recent years, according to the agency WoS (JCR), it has become a reference in its field. In the year of publication of the work, 2023, it was in position 12/97, thus managing to position itself as a Q1 (Primer Cuartil), in the category Hematology.

From a relative perspective, and based on the normalized impact indicator calculated from World Citations provided by WoS (ESI, Clarivate), it yields a value for the citation normalization relative to the expected citation rate of: 4.61. This indicates that, compared to works in the same discipline and in the same year of publication, it ranks as a work cited above average. (source consulted: ESI Nov 14, 2024)

This information is reinforced by other indicators of the same type, which, although dynamic over time and dependent on the set of average global citations at the time of their calculation, consistently position the work at some point among the top 50% most cited in its field:

  • Field Citation Ratio (FCR) from Dimensions: 29.72 (source consulted: Dimensions Aug 2025)

Specifically, and according to different indexing agencies, this work has accumulated citations as of 2025-08-06, the following number of citations:

  • WoS: 22
  • Europe PMC: 8

Impact and social visibility

From the perspective of influence or social adoption, and based on metrics associated with mentions and interactions provided by agencies specializing in calculating the so-called "Alternative or Social Metrics," we can highlight as of 2025-08-06:

  • The use of this contribution in bookmarks, code forks, additions to favorite lists for recurrent reading, as well as general views, indicates that someone is using the publication as a basis for their current work. This may be a notable indicator of future more formal and academic citations. This claim is supported by the result of the "Capture" indicator, which yields a total of: 15 (PlumX).

It is essential to present evidence supporting full alignment with institutional principles and guidelines on Open Science and the Conservation and Dissemination of Intellectual Heritage. A clear example of this is:

  • The work has been submitted to a journal whose editorial policy allows open Open Access publication.

Leadership analysis of institutional authors

There is a significant leadership presence as some of the institution’s authors appear as the first or last signer, detailed as follows: First Author (Pérez Valencia, Amanda Isabel) and Last Author (Salas Gay, María Queralt).

the author responsible for correspondence tasks has been Salas Gay, María Queralt.