Novel tool helps predict risk for heart complications after bone marrow transplant
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Researchers have created a novel tool that predicts a person’s risk for cardiovascular complications after bone marrow transplantation.
Investigators created the Cardiovascular Registry in Bone Marrow Transplantation (CARE-BMT), which collects information on patients who underwent transplant at University of Michigan Health or Rush University.
Analyses of data from more than 3,300 patients who underwent BMT between 2008 and 2019 showed 4.1% of patients experienced cardiovascular events within 100 days, and 13.9% developed such complications within 5 years.
Researchers used data from the CARE-BMT cohort to develop a risk score that uses information such as age, race, history of coronary artery disease or heart failure, and prior exposure to cardiotoxic chemotherapy.
An analysis that applied the risk score to approximately 2,400 adults identified a high-risk group that comprised about 30% of patients. These patients had cardiovascular complication rates of 31.9% at 5 years and 55% at 10 years.
“In the early days of bone marrow transplantation, when high-dose cyclophosphamide and total body irradiation were commonly used as conditioning therapy, cardiotoxicity leading to heart failure was a major concern,” Salim S. Hayek, MD, adjunct professor of internal medicine-cardiology at University of Michigan Medical School, told Healio. “This concern has persisted in contemporary BMT, despite major improvements in BMT protocols, mainly because of the lack of data on the cardiovascular risks of bone marrow transplant.”
The analyses served as the basis of a scientific statement released by the American Heart Association that addresses factors to consider during the four steps of transplant.
Healio spoke with Hayek about the motivation for developing the registry and the risk model, the model’s performance so far, and how the tool may help improve patient selection and outcomes in BMT.
Healio: What prompted your team to develop the CARE-BMT registry?
Hayek: We developed the registry to study the incidence of short-term and long-term cardiovascular effects of BMT. We found severe cardiovascular effects were much less common during the transplant itself, with abnormal heart rhythms — such as atrial fibrillation and flutter — being the most common. Long term, however, transplant survivors had a significant increase in cardiovascular disease (approximately 15%), notably heart failure and coronary disease. Death from cardiovascular disease was rare.
Healio: Can you describe the need for a better tool to predict cardiovascular complications after transplant?
Hayek: We devised the CARE-BMT risk score to provide an evidence-based framework that would help guide referrals for pre-BMT cardiovascular evaluation, optimizing resource allocation. Currently, indications for cardiovascular referral are institution-specific and are not based on any evidence. This can lead to excessive referrals or testing, delays or missing true high-risk patients. Given the long-term risk for cardiovascular disease in these patients, identifying those at high risk early can ensure their cardiovascular status is optimized prior to transplant and that they receive the appropriate follow-up after transplant.
Healio: How did you develop the risk score and how does it work?
Hayek: Using data from the CARE-BMT registry, we devised the score using commonly available clinical data that neither requires specialized testing or complex calculations. It can be calculated off a napkin. This approach makes it easy to automate and implement in electronic medical records.
Healio: How has it performed in research you have conducted so far?
Hayek: The CARE-BMT risk score performs quite well predicting both short- and long-term cardiovascular risks, with risk discrimination metrics in the range of other scores used in the clinic. It is able to clearly delineate between a low-risk and high-risk patient population. We validated the score externally and compared it with other BMT-related scores, which it outperformed.
Healio: What are the potential implications of this tool on patient selection, and potentially on outcomes?
Hayek: My hope is that this score streamlines the BMT evaluation process and helps recognize high-risk patients, leading to both improvement in the cost-effectiveness of care and long-term cardiovascular outcomes among BMT survivors.
Healio: Is this ready for use, or is more research needed?
Hayek: Given the ease of implementation and its external validation, the CARE-BMT risk score is ready to use. Data from its real-world use across health care institutions will certainly help refine and validate it.
References:
- American Heart Association. Risks, rewards and unknowns: Advancing cardiovascular care in hematopoietic stem cell transplantation. Available at: https://professional.heart.org/en/science-news/Cardiovascular-Management-of-Patients-Undergoing-Hematopoietic-Stem-Cell-Transplantation/commentary.
- Novel risk score for cardiovascular complications after bone marrow transplant (press release). Available at: https://www.michiganmedicine.org/health-lab/novel-risk-score-cardiovascular-complications-after-bone-marrow-transplant. Posted March 11, 2024. Accessed March28, 2024.
- Vasbinder A, et al. JACC CardioOncol. 2023;doi:10.1016/j.jaccao.2023.07.007.
- Vasbinder A, et al. J Am Heart Assoc. 2023;doi:10.1161/JAHA.123.033599.
For more information:
Salim S. Hayek, MD, can be reached at shayek@med.umich.edu.
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