Robin M Brusen1, Richard K Cheng1, Sophia C Masri1, Douglas Leedy2, Mohamed L Sorror3. 1. University of Washington School of Medicine, Division of Cardiology, United States of America. 2. University of Washington School of Medicine, Department of Medicine, United States of America. 3. University of Washington School of Medicine, Division of Medical Oncology, United States of America. Electronic address: msorror@fredhutch.org.
Abstract
BACKGROUND: A Hematopoietic Cell Transplantation-Specific Comorbidity Index (HCT-CI) was previously developed showing that multiple comorbidities including moderate or greater valvular heart disease to be predictors of non-relapse mortality after allogeneic HCT. However, detailed description of the impact of valve disease on outcomes is lacking. METHODS: Among a large cohort of patients given allogeneic HCT between 2000 and 2017, we identified 21 patients with moderate or severe valvular disease. We also identified a cohort of 42 controls matched on age and HCT-CI score. The primary outcome was all-cause mortality, with censoring at two years of follow-up. Secondary outcomes included mortality without relapse, duration of index admission, number of readmissions, increase in creatinine and peak troponin. RESULTS: Non-myeloablative regimens were more common in the valve disease cohort compared to controls (86% vs 54% p = 0.012). Valvular disease was associated with increased all-cause mortality with adjusted hazard ratio of 2.17 (CI 1.08-4.34, p = 0.029) and for non-relapse mortality with adjusted hazard ratio of 2.53 (CI 1.16-5.52, p = 0.020). In the valve disease cohort, creatinine increased by 1.6 vs 0.9 mg/dL (p = 0.003) and peak troponin by 1.6 vs 0.3 ng/mL (p = 0.05) compared to controls. There was no difference in readmissions or length of stay when accounting for outpatient treatment. CONCLUSIONS: Despite having similar pre-procedure risk factors and undergoing less aggressive chemotherapy regimens, patients with moderate valvular disease or greater, most of whom did not meet current guideline recommendations for repair, had worse non-relapse related outcomes with higher mortality, renal and myocardial injury.
BACKGROUND: A Hematopoietic Cell Transplantation-Specific Comorbidity Index (HCT-CI) was previously developed showing that multiple comorbidities including moderate or greater valvular heart disease to be predictors of non-relapse mortality after allogeneic HCT. However, detailed description of the impact of valve disease on outcomes is lacking. METHODS: Among a large cohort of patients given allogeneic HCT between 2000 and 2017, we identified 21 patients with moderate or severe valvular disease. We also identified a cohort of 42 controls matched on age and HCT-CI score. The primary outcome was all-cause mortality, with censoring at two years of follow-up. Secondary outcomes included mortality without relapse, duration of index admission, number of readmissions, increase in creatinine and peak troponin. RESULTS: Non-myeloablative regimens were more common in the valve disease cohort compared to controls (86% vs 54% p = 0.012). Valvular disease was associated with increased all-cause mortality with adjusted hazard ratio of 2.17 (CI 1.08-4.34, p = 0.029) and for non-relapse mortality with adjusted hazard ratio of 2.53 (CI 1.16-5.52, p = 0.020). In the valve disease cohort, creatinine increased by 1.6 vs 0.9 mg/dL (p = 0.003) and peak troponin by 1.6 vs 0.3 ng/mL (p = 0.05) compared to controls. There was no difference in readmissions or length of stay when accounting for outpatient treatment. CONCLUSIONS: Despite having similar pre-procedure risk factors and undergoing less aggressive chemotherapy regimens, patients with moderate valvular disease or greater, most of whom did not meet current guideline recommendations for repair, had worse non-relapse related outcomes with higher mortality, renal and myocardial injury.
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