JACC. Advances, Volume 5, Issue 1, 11 2 2025, Pages 102415 Prognostic Value of NT-proBNP in Patients Treated With Allogeneic Stem Cell Transplantation. Polomski EAS, von dem Borne PA, Veelken H, Heemelaar JC, Jukema JW, Antoni ML
Background
As survival rates after allogeneic stem cell transplantation (alloSCT) continue to grow, cardiovascular disease is becoming a major complication after alloSCT. However, the prognostic value of cardiac biomarkers has not been widely investigated.
Objectives
This study aims to investigate the association between baseline N-terminal prohormone of brain natriuretic peptide (NT-proBNP) in patients treated with alloSCT and mortality.
Methods
Patients who were referred for alloSCT between 2012 and 2023 were included in this single-center retrospective cohort study if NT-proBNP was measured <180 days before alloSCT. The primary study outcome was all-cause mortality and the secondary study outcome was a composite endpoint of major adverse cardiac events (acute coronary syndrome, device implantation, arrhythmias, heart failure, and pericarditis).
Results
We included 807 patients, of whom 34.5% were female with a median age of 58.6 (47.9-66.0) years who had a median NT-proBNP at baseline of 113.2 (56.9-229.4) ng/L. During follow-up of 1.6 (0.6-4.0) years, 393 patients (48.7%) died, of whom 61.8% due to a complication of alloSCT. Patients who died had a significant higher baseline NT-proBNP compared to survivors (122.4 [66.4-273.6] ng/L vs 100.2 [51.2-214.2] ng/L, P = 0.001). Patients with NT-proBNP ≥125 ng/L showed a lower 5-year survival rate (P = 0.0035). In a multivariable Cox regression model, log-transformed NT-proBNP (HR: 1.21 [95% CI: 1.11-1.31], P < 0.001) and NT-proBNP ≥125 ng/L (HR: 1.29 [95% CI: 1.04-1.60], P = 0.020) were positively associated with increased risk of death.
Conclusions
Baseline NT-proBNP in patients treated with alloSCT is positively associated with an increased risk of all-cause mortality. NT-proBNP ≥125 ng/L was associated with a significant lower 5-year survival.
