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Fatal cardiac complications can occur from the early to late phases after hematopoietic cell transplantation (HCT). Herein, the Japanese transplant registry database was used to retrospectively analyze health records of 33,791 allogeneic HCT recipients to elucidate the pathogenesis and risk factors involved. Overall, 527 patients died of cardiac complications at a median of 130 (range 0–3924) days after HCT. The cumulative incidence of fatal cardiac complications was 1.2% (95% confidence interval [CI]: 1.0–1.3) and 1.6% (95% CI: 1.5–1.8) at 1 and 5 years after HCT, respectively. Fatal cardiovascular events were significantly associated with an HCT‐specific comorbidity index (HCT‐CI) score of ≥1 specific to the three cardiovascular items, lower performance status, conditioning regimen cyclophosphamide dose of >120 mg/kg, and female sex. Cardiovascular death risk within 60 days after HCT was associated with the type of conditioning regimen, presence of bacterial or fungal infections at HCT, and number of blood transfusions. Contrastingly, late cardiovascular death beyond 1 year after HCT was associated with female sex and older age. Lower performance status and positive cardiovascular disease‐related HCT‐CI were risk factors for cardiac complications in all phases after HCT. Systematic follow‐up may be necessary according to the patients' risk factors and conditions. [ABSTRACT FROM AUTHOR]

The impact of conditioning intensity on different donor groups has been unclear in allogeneic transplantation. The objective of this study was to clarify the effect of conditioning intensity on disease‐free survival (DFS), relapse, non‐relapse mortality (NRM), neutrophil engraftment, and graft‐versus‐host disease for each donor type. We retrospectively evaluated the effect of conditioning intensity on transplant outcomes for patients with acute leukemia or myelodysplastic syndrome aged between 16 and 60 years in Japan using the transplant conditioning intensity (TCI) scoring system. A total of 8526 patients who received first allogeneic transplantation from 6/6 antigen‐matched sibling donor (MSD, n = 2768), 8/8 allele‐matched unrelated donor (MUD, n = 2357), and unrelated single‐cord blood (UCB, n = 3401) were eligible for the analyses. Compared to conditioning with TCI score 4.0, which was corresponds to conventional myeloablative conditioning, including cyclophosphamide with total body irradiation 12 Gy or busulfan 12.8 mg, and was considered as the reference group in the multivariate analyses, intensified conditioning with TCI score ≥4.5 improved DFS (hazard ratio [HR],0.81, P < 0.001) and relapse rate (HR, 0.70, P < 0.001) but only after UCB transplants and not MSD and MUD transplants. In contrast, NRM was higher after intensified conditioning with TCI score ≥4.5 for MSD (HR, 1.39, P = 0.008) and MUD (HR, 1.47, P = 0.002) transplants but not UCB transplants (HR, 1.12, P = 0.240). Neutrophil engraftment was also significantly higher after intensified conditioning with TCI score ≥4.5 but only for UCB transplants (HR, 1.24, P < 0.001), whereas it was significantly lower after reduced‐intensity conditioning with TCI score ≤3.5 for MSD transplants only (HR, 0.82, P < 0.001). These data demonstrated that an intensified conditioning regimen improved survival and engraftment rate only after a UCB transplants. Therefore, TCI scoring system could enable the optimization of conditioning intensity according to donor type, particularly in terms of survival and engraftment. [ABSTRACT FROM AUTHOR]

The introduction of tyrosine kinase inhibitors (TKIs) in chronic myeloid leukemia (CML) treatment has dramatically improved the prognosis of CML patients and reduced the number of patients receiving allogeneic stem cell transplantation (allo‐SCT). However, the impact of the newest‐generation TKIs on the overall survival (OS) after allo‐SCT has not been well described. To investigate the beneficial effects of TKIs on the prognosis after allo‐SCT, we conducted a retrospective observational study using the Transplant Registry Unified Management Program database in Japan. We analyzed 1188 patients (male/female: 738/450; median age: 44 years; range: 16–75) who underwent their first allo‐SCT between January 2001 and December 2018. We divided the patients into two groups according to the TKI treatment used before allo‐SCT: group 1 was treated with the first generation TKI imatinib; group 2 was treated with the second generation TKIs nilotinib, dasatinib, or bosutinib and/or the third generation TKI ponatinib. We compared the post allo‐SCT OS between the two groups. The 3‐year OS rates (95%CI) of groups 1 and 2 were 59.3% (54.8%–63.5%) and 65.8% (61.6%–69.6%), respectively (p = 0.017). Multivariate analysis confirmed that group 2 had superior OS after allo‐SCT compared to group 1 (p = 0.002). Other factors associated with superior prognosis were age ≤65, performance status (PS) 0/1, a 6/6 HLA‐matched donor and chronic‐phase (CP) disease status at allo‐SCT. A subgroup analysis showed poor prognoses for patients who could not obtain a molecular response before allo‐SCT and patients with positive T315I mutation in the BCR/ABL gene. In group 2, early allo‐SCT was correlated with superior OS in patients with a blast‐crisis disease status at allo‐SCT (p = 0.001). The cumulative incidence of non‐relapse mortality rate significantly decreased in group 2 (p = 0.0005). The post allo‐SCT OS was improved both by pre‐ and post‐management of allo‐SCT and by the introduction of newer TKIs. [ABSTRACT FROM AUTHOR]