Prediction of cardiovascular disease among hematopoietic cell transplantation survivors

Area of Science:

• Hematology
• Cardiology
• Oncology

Background:

• Cardiovascular disease (CVD) is a major cause of long-term mortality in hematopoietic cell transplantation (HCT) survivors.
• Existing CVD risk prediction models lack specificity for HCT populations, necessitating tailored approaches for early screening and prevention.

Purpose of the Study:

• To develop and validate HCT-specific risk prediction models for cardiovascular disease (CVD), including heart failure (HF) and coronary artery disease (CAD).
• To stratify HCT survivors into distinct risk groups for CVD to guide clinical management and interventions.

Main Methods:

• Development of integer risk scores using data from 1828 HCT survivors at City of Hope (COH), followed for 10-year CVD incidence.
• Validation of the COH models using an independent case cohort of 580 HCT survivors from the Fred Hutchinson Cancer Research Center.
• Risk scores were based on variables including age, anthracycline dose, chest radiation, hypertension, diabetes, and smoking.

Main Results:

• The developed risk scores demonstrated good predictive performance, with an area under the curve (AUC) of 0.74 for overall CVD.
• Validation cohort AUCs ranged from 0.66 to 0.75, confirming model generalizability.
• Risk stratification identified low (3.7%), intermediate (9.9%), and high (26.2%) 10-year CVD cumulative incidences, with significantly elevated risks for intermediate and high-risk groups.

Conclusions:

• Validated HCT-specific CVD risk models can effectively identify survivors at increased risk for HF and CAD.
• These models provide a framework for refining screening protocols and developing targeted interventions to mitigate CVD post-HCT.
• Early identification and risk stratification are crucial for improving long-term outcomes in HCT survivors.