Impact of Dimethyl Sulfoxide on Early Cardiotoxicity After Allogeneic Hematopoietic Stem Cell Transplantation

Abstract

During the COVID-19 pandemic, the use of cryopreserved grafts in allogeneic hematopoietic stem cell transplantation (HSCT) increased substantially. Dimethyl sulfoxide (DMSO), used as a cryoprotective agent, is well recognized for its infusion-related toxicity; however, its impact on cardiac function remains unclear. Methods: This prospective study included 96 consecutive patients (median age 46 years) undergoing allogeneic HSCT. Patients were divided according to graft type into cryopreserved (n = 59, 61.5%) and non-cryopreserved (n = 37, 38.5%) groups. Comprehensive echocardiographic assessment was performed before and after transplantation. Results: Significant changes were observed in diastolic parameters (E/A, and E/E′), structural parameters (left ventricular mass and left ventricular mass index), global longitudinal strain (GLS), and right ventricular ejection fraction following HSCT. In the cryopreserved group, E/A ratio decreased below the normal range and E/E′ ratio increased significantly, whereas no such changes were observed in the non-cryopreserved group. During the 30-day follow-up period, symptomatic cardiovascular toxicity occurred in 5 patients (5.2%), while subclinical cancer therapy-related cardiac dysfunction was detected in 16 patients (16.7%). Receiver operating characteristic (ROC) analysis demonstrated that GLS predicted cardiotoxicity with an area under the curve (AUC) of 0.88 (95% CI, 0.79–0.98; p < 0.0001). At a cut-off value of − 16.8%, sensitivity was 100% and specificity was 79%. Conclusion: Cryopreserved graft administration may be associated with early alterations in left ventricular diastolic function, potentially reflecting DMSO-related cardiotoxicity. GLS appears to be a sensitive marker for the early detection and prediction of cardiotoxicity in patients undergoing allogeneic HSCT.