{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T21:17:55Z","timestamp":1792271875554,"version":"4.4.0"},"reference-count":38,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2025,9,26]],"date-time":"2025-09-26T00:00:00Z","timestamp":1758844800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.mdpi.com"],"crossmark-restriction":true},"short-container-title":["Cancers"],"abstract":"<jats:p>Background: Post-transplant cyclophosphamide (PTCy) is a standard graft-versus-host disease (GVHD) prophylaxis in allogeneic hematopoietic cell transplantation (allo-HCT). While effective, concerns remain about cyclophosphamide-related cardiotoxicity, especially in patients with pre-existing cardiac morbidity, a population often underrepresented in clinical trials. Objectives: To assess the incidence and outcomes of early (ECE, \u2264100 days) and late (LCE, &gt;100 days) cardiac events in acute myeloid leukemia (AML) patients with and without baseline cardiac morbidity undergoing allo-HCT with PTCy. Study Design: Retrospective multicenter study by the Grupo Espa\u00f1ol de Trasplante Hematopoy\u00e9tico y Terapia Celular (GETH-TC) including 461 AML patients (62 with cardiac morbidity) transplanted between 2012 and 2022. Cardiac morbidity was defined by documented cardiac disease or left ventricular ejection fraction &lt; 45%. Cumulative incidence, overall survival (OS), and non-relapse mortality (NRM) were analyzed using competing risks models and adjusted with propensity score matching (PSM) and inverse probability weighting (IPW). Results: Cardiac events occurred in 13.2% of patients: 11% vs. 7% ECE (p = 0.93) and 8% vs. 5.3% LCE (p = 0.85) in those with vs. without cardiac morbidity. Most ECEs were arrhythmias or heart failure. Adjusted analyses confirmed no significant differences in CE incidence, OS, or NRM between groups. Two-year OS was 69% vs. 70% (p = 0.50); NRM was 18% vs. 17% (p = 0.20). ECE was associated with higher mortality in both groups. Conclusions: PTCy is feasible in AML patients with pre-existing cardiac morbidity when combined with comprehensive cardiovascular evaluation and cardio-oncology follow-up, supporting its safe use in broader patient populations with appropriate cardiologic support.<\/jats:p>","DOI":"10.3390\/cancers17193128","type":"journal-article","created":{"date-parts":[[2025,9,26]],"date-time":"2025-09-26T09:35:49Z","timestamp":1758879349000},"page":"3128","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Safety of Post-Transplant Cyclophosphamide-Based Prophylaxis in AML Patients with Pre-Existing Cardiac Morbidity Undergoing Allogeneic Hematopoietic Cell Transplantation"],"prefix":"10.3390","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-3475-3736","authenticated-orcid":false,"given":"Arnau","family":"Torrent-Rodr\u00edguez","sequence":"first","affiliation":[{"name":"Hospital Cl\u00ednic de Barcelona, 08036 Barcelona, Spain"},{"name":"Faculty of Medicine and Health Sciences, Universitat de Barcelona, 08907 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Enric","family":"Cascos","sequence":"additional","affiliation":[{"name":"Hospital Cl\u00ednic de Barcelona, 08036 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6925-4605","authenticated-orcid":false,"given":"V\u00edctor Navarro","family":"Garc\u00e9s","sequence":"additional","affiliation":[{"name":"Statistics Unit, Vall d\u2019Hebron Institute of Oncology (VHIO), 08035 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0732-3235","authenticated-orcid":false,"given":"Estefan\u00eda","family":"P\u00e9rez-L\u00f3pez","sequence":"additional","affiliation":[{"name":"Hematology Department, Complejo Asistencial Universitario de Salamanca\/IBSAL, 37007 Salamanca, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M\u00f3nica","family":"Baile-Gonz\u00e1lez","sequence":"additional","affiliation":[{"name":"Hematology Department, Complejo Asistencial Universitario de Salamanca\/IBSAL, 37007 Salamanca, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9621-2133","authenticated-orcid":false,"given":"Carlos Mart\u00edn","family":"Rodr\u00edguez","sequence":"additional","affiliation":[{"name":"Hematology Department, Complejo Asistencial Universitario de Salamanca\/IBSAL, 37007 Salamanca, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mar\u00eda Jes\u00fas Pascual","family":"Casc\u00f3n","sequence":"additional","affiliation":[{"name":"Hematology Department, Hospital Regional Universitario de M\u00e1laga, 29010 M\u00e1laga, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marta","family":"Luque","sequence":"additional","affiliation":[{"name":"Hematology Department, Hospital Regional Universitario de M\u00e1laga, 29010 M\u00e1laga, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Albert","family":"Esquirol","sequence":"additional","affiliation":[{"name":"Hematology Department, Hospital de la Santa Creu i Sant Pau, 08025 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9574-0383","authenticated-orcid":false,"given":"Carmen Mart\u00edn","family":"Calvo","sequence":"additional","affiliation":[{"name":"Hematology Department, Hospital Reina Sof\u00eda de C\u00f3rdoba, 14004 C\u00f3rdoba, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2667-716X","authenticated-orcid":false,"given":"Felipe","family":"Pe\u00f1a-Mu\u00f1oz","sequence":"additional","affiliation":[{"name":"Institut Catal\u00e0 d\u2019Oncologia, Hospital Duran i Reynals, 08907 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Inmaculada Heras","family":"Fernando","sequence":"additional","affiliation":[{"name":"Hematology Division, Hospital Morales Meseguer, 30008 Murcia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Itziar Oiartzabal","family":"Ormtegi","sequence":"additional","affiliation":[{"name":"Hematology Department, Hospital Universitario Donostia, 20080 Donostia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7372-5219","authenticated-orcid":false,"given":"Adolfo Jes\u00fas 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Canaria, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-6400-7422","authenticated-orcid":false,"given":"Luc\u00eda","family":"Garc\u00eda-Ma\u00f1o","sequence":"additional","affiliation":[{"name":"Hematology Department, Hospital Universitatio Son Espases, 07120 Palma de Mallorca, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0565-9133","authenticated-orcid":false,"given":"Ana Pilar","family":"Gonz\u00e1lez-Rodriguez","sequence":"additional","affiliation":[{"name":"Hematology Department, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tamara","family":"Torrado","sequence":"additional","affiliation":[{"name":"Hematology Department, Hospital Universitario de A Coru\u00f1a, 15006 A Coru\u00f1a, 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