# Prognostic Value of NT-proBNP in Patients Treated With Allogeneic Stem Cell Transplantation

## TL;DR

This study shows that higher levels of NT-proBNP before stem cell transplantation are linked to higher mortality risk in patients.

## Contribution

The study identifies NT-proBNP as a novel prognostic biomarker for mortality in allogeneic stem cell transplant recipients.

## Key findings

- Patients who died had significantly higher baseline NT-proBNP levels than survivors.
- NT-proBNP ≥125 ng/L was associated with lower 5-year survival rates.
- NT-proBNP was independently linked to increased mortality risk in a multivariable model.

## Abstract

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.

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.

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).

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.

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.