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This study identified two plasma proteins, carboxypeptidase vitellogenic-like protein (CPVL) and poly immunoglobulin receptor (PIGR), whose baseline levels before anthracycline chemotherapy correlate strongly with the development of systolic dysfunction in patients with hematologic malignancies. Validation in both an independent patient cohort and a murine doxorubicin cardiotoxicity model supports their role as predictive biomarkers. Moreover, increased IgA+ B cells linked to PIGR suggest an immune-adaptive mechanism underlying cardiotoxicity. Elevated CPVL and PIGR levels predicted poorer overall survival, emphasizing clinical relevance.
