Hematopoietic cell transplantation survivors classified as high-risk by a novel prediction model had a 7.8-fold higher risk of developing cardiovascular disease at 10 years compared to low-risk survivors (95% CI 5.0-12.2).
Cohort (n=2,408)
Yes
Does a risk prediction model based on clinical and treatment variables accurately predict the 10-year risk of cardiovascular disease in hematopoietic cell transplantation survivors?
A validated risk prediction model incorporating age, cardiovascular risk factors, and cancer therapies can effectively stratify the 10-year risk of cardiovascular disease in hematopoietic cell transplantation survivors.
Relative Risk: 7.8 (95% CI 5–12.2)
Absolute Event Rate: 26.2% vs 3.7%
Cardiovascular disease (CVD) is a leading cause of late morbidity and mortality in hematopoietic cell transplantation (HCT) survivors. HCT-specific CVD risk prediction models are needed to facilitate early screening and prevention. In the current study, patients who underwent HCT at City of Hope (COH) and survived 1-year free of clinically evident CVD (N = 1828) were observed for the development of heart failure (HF) or coronary artery disease (CAD) by 10-years from index date (1 year from HCT). CVD occurred in 135 individuals (92 HF, 43 CAD). Risk prediction models were developed for overall CVD (HF and/or CAD) using COH-derived integer risk scores. Risk scores based on selected variables (age, anthracycline dose, chest radiation, hypertension, diabetes, smoking) achieved an area under the curve (AUC) and concordance (C) statistic of 0.74 and 0.72 for CVD; these varied from 0.70 to 0.82 according to CVD subtype (HF or CAD). A Fred Hutchinson Cancer Research Center case cohort (N = 580) was used to validate the COH models. Validation cohort AUCs ranged from 0.66 to 0.75. Risk scores were collapsed to form statistically distinct low-, intermediate-, and high-risk groups, corresponding to 10-year cumulative incidences of CVD of 3.7%, 9.9%, and 26.2%, respectively. Individuals in the high- and intermediate-risk groups were at 7.8-fold (95% confidence interval, 5.0-12.2) and 2.9-fold (95% confidence interval, 1.9-4.6) risk of developing CVD (referent group: low risk). These validated models provide a framework on which to modify current screening recommendations and for the development of targeted interventions to reduce the risk of CVD after HCT.
Armenian et al. (Mon,) conducted a cohort in Hematopoietic cell transplantation (HCT) survivors (n=2,408). High-risk classification (based on age, anthracycline dose, chest radiation, hypertension, diabetes, smoking) vs. Low-risk classification was evaluated on Overall cardiovascular disease (heart failure and/or coronary artery disease) (7.8-fold risk, 95% CI 5.0-12.2). Hematopoietic cell transplantation survivors classified as high-risk by a novel prediction model had a 7.8-fold higher risk of developing cardiovascular disease at 10 years compared to low-risk survivors (95% CI 5.0-12.2).