Sex differences in cardiovascular complications after allogeneic hematopoietic stem cell transplantation
Bibliographic record
Abstract
Abstract Background Allogeneic hematopoietic stem cell transplantation (AHSCT) represents a major therapeutic challenge in the treatment of hematologic malignancies. However, the conditioning regimens, including chemotherapy and radiotherapy, are associated with both short- and long-term cardiotoxicity, increasing the risk of major adverse cardiovascular events (MACE). While sex-based differences in cardiovascular disease (CVD) have been extensively documented in the general population, their impact on AHSCT outcomes and the development of subsequent CVD remains poorly known. Purpose To investigate sex differences in AHSCT outcomes and identify independent predictors of MACE by sex in a large cohort of AHSCT patients. Methods Between 2011 and 2020, we conducted a retrospective, single-centre longitudinal cohort study including all consecutive patients with hematologic malignancies undergoing AHSCT. The primary composite outcome was MACE, including cardiovascular death, incident heart failure (HF), rhythm/conduction disorders, acute arterial events, venous thromboembolism (VTE), and myopericarditis. A propensity score matching was performed to balance characteristics between males and females. Predictors of MACE were analysed using Cox proportional hazards regression. Results In the propensity-score matched population (N=786 patients, 50% males and 50% females, mean age 44±16 years), 30% patients experienced MACE after a median (IQR) follow-up of 4 (1-7) years. The cumulative incidence of early MACE (≤100 days) was similar between males and females (12.6% versus 13.8%, p=0.67), with the primary causes being HF and supraventricular arrhythmia in males, and HF and pericardial disease in females. At 4 years, the cumulative incidence of late MACE remained comparable between males and females (17.3% vs. 18.1%, p=0.91), with HF, VTE, and pericardial disease as the predominant causes. Among males, the following variables were identified as predictors of early MACE: history of hypertension (HR: 2.16; 95% CI: 1.07–4.33; p=0.031), smoking status (HR: 1.90; 95% CI: 1.08–3.35; p=0.026), history of supraventricular arrhythmia (HR: 3.43; 95% CI: 1.07–11.0; p=0.039), history of cancer-therapy related cardiac dysfunction (HR: 5.51; 95% CI: 2.18–13.9; p<0.001), previous use of liposomal anthracyclines (HR: 2.83; 95% CI: 1.02–7.89; p=0.046), age (HR: 1.02; 95% CI: 1.00–1.04; p=0.022), and haploidentical donor transplant (HR: 3.18; 95% CI: 1.40–7.22; p=0.006). In males, predictors of early MACE included history of hypertension (HR: 2.34; 95% CI: 1.23–4.45; p=0.009), history of HF (HR: 3.70; 95% CI: 1.34–10.3; p=0.012), and left ventricular ejection fraction (HR: 0.96; 95% CI: 0.92–1.00; p=0.039). Conclusion After propensity score matching, the risk of early and late MACE was similar between males and females following AHSCT. However, sex-specific differences in predictors may suggest the need for sex-specific risk stratification prior to AHSCT. Study population
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".