Atrial fibrillation strikes more often after allogeneic than autologous stem cell transplants

Atrial fibrillation, the most common acute cardiovascular complication after hematopoietic cell transplantation, develops more often within the first 90 days in recipients of donor-derived (allogeneic) transplants than in patients receiving their own cells (autologous transplants), according to a large retrospective cohort study published in the journal Cardio-Oncology.

Among this group, atrial fibrillation occurred in 6.3 percent of allogeneic recipients compared with 4.3 percent of autologous recipients, a difference that was statistically significant (Gray’s test P < 0.001).

The study population was middle-aged to older adults. The median age was 54 years, with a range of 18 to 82, among allogeneic recipients, and 59 years, with a range of 18 to 78, among autologous recipients.

In allogeneic recipients, two factors were associated with increased risk of early-onset atrial fibrillation. Patients aged 50 years or older had more than twice the risk of younger patients, with an adjusted sub-distribution hazard ratio of 2.85 (P < 0.0001). A lower Karnofsky performance score, below 80 on the standard 100-point scale of functional status, was also associated with increased risk, with an adjusted hazard ratio of 1.69 (P = 0.03).

In autologous recipients, three factors were linked to elevated risk. Older age carried an adjusted hazard ratio of 2.49 (P = 0.006), a Karnofsky performance score below 80 carried an adjusted hazard ratio of 2.41 (P = 0.0001), and obesity was associated with an adjusted hazard ratio of 1.68 (P = 0.015).

The authors conclude that cumulative incidence of atrial fibrillation within 90 days after HCT is higher in allogeneic than in autologous transplant patients, and that recipients who are older, have a lower Karnofsky performance score, or have obesity face an increased risk of early-onset AF after transplantation.

The findings come from a retrospective cohort design, which can identify associations but cannot establish causation. The analysis was limited to patients without pre-existing arrhythmia, cardiac disease, or valvular heart disease, so the results apply to recipients who were free of these conditions before transplant. The published version is an early-release, peer-reviewed accepted manuscript that may be subject to further edits before the final version of record.

Subject of Research: Incidence and risk factors for early-onset atrial fibrillation after allogeneic and autologous hematopoietic stem cell transplantation

Article Title: Atrial fibrillation in allogeneic and autologous hematopoietic stem cell transplant recipients: incidence and clinical implications

Article References: Cai, L., Ma, H., Chiu, K., Cunningham, C., & Taplitz, R. (2026). Atrial fibrillation in allogeneic and autologous hematopoietic stem cell transplant recipients: incidence and clinical implications. Cardio-Oncology. https://doi.org/10.1186/s40959-026-00574-z

Image Credits: AI Generated

DOI: 10.1186/s40959-026-00574-z

Keywords: atrial fibrillation, hematopoietic cell transplant, allogeneic transplant, autologous transplant, cardio-oncology, retrospective cohort study, risk factors, Karnofsky performance score, obesity, transplant complications, Atrial, fibrillation