Successful allogeneic stem cell transplant in a patient with a left ventricular assist device: a novel case report

Historically, severe heart failure has been considered a contraindication for hematopoietic stem cell transplant (HSCT). Despite the growing use of the left ventricular assist device (LVAD), clinicians have avoided HSCT in patients with hematologic malignancies and an LVAD due to a multitude of potential complicating factors, including the use of cardiotoxic conditioning regimens and severe post-transplant thrombocytopenia requiring anticoagulation interruption. Currently, there are no published reports of a successful allogeneic HSCT in a patient with an LVAD. The case herein documents a 36-year-old man with acute myeloid leukemia (AML) and post-induction systolic heart failure necessitating LVAD (HeartMate 3) placement, who later successfully underwent allogeneic HSCT and is now in remission. We highlight preparative regimen considerations, the need to account for the effects of irradiation on the LVAD and external controller, and the importance of a multidisciplinary care team to demonstrate that the presence of an LVAD does not necessarily preclude patients with AML from potentially curative HSCT, particularly when managed with careful coordination and individualized risk-adapted strategies.