BACKGROUND: In patients with bone marrow transplantation (BMT) for hematologic malignancies, evidence for prevention of cancer therapy-related cardiac dysfunction (CTRCD) remains limited.

OBJECTIVES: The authors investigated whether early initiation of sacubitril/valsartan or enalapril could be helpful to prevent CTRCD in patients undergoing BMT.

METHODS: We randomized 90 patients with preserved left ventricular ejection fraction (LVEF) after BMT to sacubitril/valsartan, enalapril, or no cardioprotective medication (controls). The primary endpoints included i) LVEF, ii) LV global longitudinal strain (GLS), iii) myocardial wasted work (GWW), and work efficiency (GWE) by speckle tracking echocardiography. Secondary endpoints included changes in LV volumes.

RESULTS: Patients treated with sacubitril/valsartan or enalapril for 6 months did not show a deterioration of LV GLS or LVEF (P > 0.05). Conversely, controls showed impaired LV GLS (-20.9% ± 2.1% vs -18.8% ± 2.6%, P = 0.001) and reduced LVEF (P = 0.045) at 6 months post-BMT. The percent improvement of GWW and GWE was greater in the sacubitril/valsartan compared to enalapril or control group (P = 0.044 and P = 0.011, respectively) at 6 months. Conversely, in controls, GWW increased (80.7 ± 60.6 vs 115.3 ± 52.1 mm Hg%, P = 0.045), and GWE was compromised (P = 0.030) at 6 months post-BMT. Among the 3 treatment groups, only sacubitril/valsartan group showed a reduction in LV end-diastolic and systolic volume compared to baseline (102.3 ± 26.9 vs 93.2 ± 18.9 mL, P = 0.042 and 44.5 ± 15.4 vs 39.1 ± 10.1 mL, P = 0.012, respectively).

CONCLUSIONS: Treatment with sacubitril/valsartan or enalapril prevented deterioration of myocardial function at 6 months in patients with hematologic malignancies treated with BMT. Moreover, sacubitril/valsartan showed a more favorable effect on myocardial work indices. (Effect of Angiotensin Converting Enzyme and Sacubitril Valsartan in Patients After Bone Marrow Transplantation; NCT04092309).