Modeling Risk of Atrial Fibrillation in Stem Cell Transplant

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Conference Proceeding

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Transplant Cell Ther


Development of Atrial fibrillation (AF) in patients undergoing hematopoietic stem cell transplant (HSCT) is associated with longer hospital stay, increased intensive care admission, and higher mortality within 1 year of HSCT (Tonorezos et al). Studies have reported clonal hematopoiesis, renal dysfunction, dilated left atrium (LA), hypertension (HTN), and left ventricular systolic dysfunction as risk factors for developing AF post-HSCT. Our aim is to find predictors of AF based on pre-HSCT clinical and echocardiographic parameters.

Methods: This is a single center retrospective study, involving 748 consecutive patients undergoing autologous and allogenic HSCT from 2012 to 2022. Patients’ charts were reviewed to acquire clinical information (age, gender, HTN, body mass index [BMI], Obstructive sleep apnea [OSA]) and LA volume index was obtained from pre-HSCT echocardiogram.

Results: For the 748 patients, the median age at HSCT was 61. Majority of patients were male (57%). Most common diagnoses were Myeloma (42.5%), acute leukemia (19.5%), lymphoma (19.5%), myelodysplastic syndromes and myeloproliferative neoplasms (11%). A total of 116 (15.5%) patients developed AF early post-HSCT. We found that compared to patients who did not develop AF early post HSCT, the AF patients had larger left atrial size, were significantly older, and were significantly more likely to have OSA. AF patients’ mean LA measurement was 37.3ml/m2, whereas non-AF patients’ mean measure was 30.6ml/m2 (P-value: 0.002). For age at HSCT, AF patients’ mean was 62.4 years old and non-AF patients’ mean was 57.4 years old (P-value: <0.001). OSA diagnosis, 39 (29.5%) of AF patients had OSA and 67 (11.3%) of non-AF patients had OSA (P-value: <0.001). In the multivariable regression analysis, larger LA size (P-value: 0.016), older age at HSCT (P-value: 0.001), and diagnosis of OSA (P-value: <0.001) were stillsignificant predictors of AF. Male gender, HTN, BMI, and use of ATG or Melphalan based chemotherapies were not predictive of AF post-HSCT.

Conclusion: In our single center retrospective study, we found diagnosis of OSA, older age at HSCT, and enlarged LA as significant predictors of AF early post-HSCT. A limitation of our study is the diagnosis of OSA, which sometimes was not supported with a sleep study or diagnosis came from an external practitioner. Further research is needed to develop a risk calculator to identify high risk patients and also study the effects of prophylactic therapies on the incidence of Post-HSCT AF.





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