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
News Source: Drew Townsend. (October 28, 2026). Atrial fibrillation strikes more often after allogeneic than autologous stem cell transplants. Scienmag.
