Key result
Very high-risk HFA-ICOS score is linked to ~40.4-fold higher cardiovascular event risk with R-COMP.
Why the study?
Does the HFA-ICOS risk score effectively stratify mortality and cardiovascular event risk in patients with newly diagnosed non-Hodgkin lymphoma treated with non-PEGylated liposomal doxorubicin (R-COMP)?
Cohort (n=265)
Does the HFA-ICOS risk score effectively stratify mortality and cardiovascular event risk in patients with newly diagnosed non-Hodgkin lymphoma treated with non-PEGylated liposomal doxorubicin (R-COMP)?
Answers are grounded in this paper and cite their sources.
Validates the HFA-ICOS score for predicting cardiovascular events and mortality in elderly non-Hodgkin lymphoma patients treated with non-PEGylated liposomal anthracycline (R-COMP).
BACKGROUND: Elderly patients with non-Hodgkin lymphoma and cardiovascular disease are frequently treated with regimens incorporating non-PEGylated liposomal anthracycline to mitigate cardiotoxicity while preserving antitumor efficacy. However, considering their unique pharmacokinetics, validation of a cardiovascular risk stratification tool for these patients is much needed. METHODS: We retrospectively analyzed patients with newly diagnosed non-Hodgkin lymphoma treated with rituximab, cyclophosphamide, non-PEGylated liposomal doxorubicin, vincristine, and prednisone (R-COMP) between 2014 and 2025. Baseline demographics, cardiovascular history and medications, echocardiographic and laboratory parameters were recorded. Patients were stratified into risk categories according to the Heart Failure Association International Cardio-Oncology Society (HFA-ICOS) score. Outcomes included overall survival (OS), progression-free survival (PFS) and incidence of cardiovascular events defined as asymptomatic left ventricular dysfunction, new-onset or worsening heart failure and acute coronary syndrome. RESULTS: The cohort consisted of 265 patients [median age 73 years (69-77); 51% males]; 41% were classified as moderate risk, 55% as high risk, and 4% as very high risk. During a median follow-up of 29 months, 38 patients (14%) died. OS and cardiovascular events occurrence significantly differed across the three HFA-ICOS risk categories; in particular, very high-risk patients exhibited substantially higher hazards of mortality (HR 5.8) and cardiovascular events (HR 40.4). Cardioprotective therapy at baseline appears not influence cardiovascular outcomes. CONCLUSIONS: The HFA-ICOS score effectively stratifies mortality and risk of cardiovascular events among patients treated with R-COMP. Despite the limited number of very-high risk patients and the heterogenous, non-randomized cardioprotective strategies at baseline, our findings may provide evidence supporting its integration into practice.
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Camilli et al. (2026) conducted a cohort in Newly diagnosed non-Hodgkin lymphoma treated with R-COMP (n=265). Very high-risk HFA-ICOS score vs. Moderate or high-risk HFA-ICOS score was evaluated on Overall survival and incidence of cardiovascular events (asymptomatic left ventricular dysfunction, new-onset or worsening heart failure, and acute coronary syndrome) (HR 40.4). Very high-risk HFA-ICOS patients treated with R-COMP had substantially higher hazards of cardiovascular events (HR 40.4) and mortality (HR 5.8) over a median 29 months of follow-up.
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