New tool to predict risk of cardiovascular complications after bone marrow transplantation

For thousands of Americans each year, bone marrow transplants have the potential to cure diseases such as leukemia, lymphoma, and immunodeficiency diseases. Bone marrow transplantation, while lifesaving, is a burdensome procedure that can affect various organs, including the cardiovascular system.

With advances in medicine and improved protocols, bone marrow transplants, also known as hematopoietic stem cell transplants, are increasingly being offered to older patients who are at higher risk for cardiovascular disease.

Michigan Medicine-led researchers not only determined the current prevalence of cardiovascular complications after bone marrow transplantation. They have developed a new tool to help predict a person’s risk of developing such problems after surgery and guide them through the pre-transplant process.

“In the early days of bone marrow transplantation, cardiac patients were often excluded due to the cardiotoxicity of the conditioning therapies used at the time,” said Dr. Professor Salim Hayek, MD, says: in cardio-oncology.

“Understanding the cardiovascular risks of modern bone marrow transplants is critical to selecting appropriate patients and ensuring that they are not excluded unnecessarily. This is the first modern evidence showing how to assess vascular risk.” Complications – Taken together, these can help clinicians ensure better outcomes with this procedure. ”

Cardiovascular risks after transplantation

Hayek and his team have built the Cardiovascular Registry in Bone Marrow Transplant, known as CARE-BMT, which brings together data on patients who received transplants from both Michigan Health University and Rush University.

In a study of more than 3,300 people who underwent bone marrow transplantation between 2008 and 2019, 4.1% of patients experienced a cardiovascular event within 100 days after surgery, and 13.9% experienced a cardiovascular event 5 years later. experienced.

Result is, JACC Cardio-Oncology.

rare complications

Overall, cardiovascular complications during hospitalization for bone marrow transplantation were rare. The most common short-term and long-term symptom was atrial fibrillation, with 6.8% of patients diagnosed at 5 years, followed by heart failure, with 5.4% of patients experiencing heart failure. Serious cardiovascular complications, such as heart attacks and strokes, were rare.

The researchers also found that 16.4% of allogeneic transplant recipients who received bone marrow from another donor developed long-term cardiovascular events five years after replacing damaged bone marrow with their own healthy blood stem cells. compared with 12.1% of autologous transplant recipients.

The landscape of bone marrow transplantation has evolved rapidly over the past 20 years, with many improvements in patient selection and treatment methods for bone marrow transplantation.

Our cohort allowed us to re-evaluate the incidence of cardiovascular complications in patients who received more modern treatments. ”

Dr. Salim Hayek, Adjunct Professor of Internal Medicine and Cardiology, UM School of Medicine

Patients with pre-existing cardiovascular disease, such as diabetes or coronary artery disease, are more likely to develop complications in the long term, but not during the transplant process.

“Determining who is at high or low risk for cardiovascular disease outcomes is critical to guiding both pre-transplant assessment and post-transplant management. “We’ve invested heavily in creating risk scores that can be used to identify these patients,” said lead author Alexi, who was a postdoctoral fellow at the UM Frankel Heart and Vascular Center at the time the study was conducted. said Dr. Vasbinder, RN.

Risk cardiovascular score before bone marrow transplantation

To develop such a tool, researchers used data from the CARE-BMT cohort. They create a simple point-based risk score using easily accessible clinical information such as age and race, history of coronary artery disease or heart failure, and previous doses of cardiotoxic chemotherapy drugs. Did.

In an analysis of more than 2,400 adult patients, the final risk model, now known as the CARE-BMT risk score, identified high-risk groups representing more than 30% of patients. The cardiovascular complication rate after 5 years was 31.9%. After 10 years he rose to 55%.

This score performed similarly well in allogeneic and autologous bone marrow transplant patients, as well as in a separate cohort of more than 900 patients at Rush University.

Result is, Journal of the American Heart Association.

“This is a very simple score that can be easily calculated and incorporated into any medical record,” Hayek said.

“It is easily reproducible and can be used during pre-bone marrow transplant evaluation to refer high-risk patients to cardiologists and optimize medical and lifestyle management of the patient’s condition.”

AHA Scientific Statement

These two reports form the basis of a scientific statement published by the American Health Association covering the cardiovascular management of patients undergoing bone marrow transplantation.

This statement addresses considerations during the four steps of hematopoietic stem cell transplantation: pretransplant evaluation, conditioning therapy and engraftment, the immediate posttransplant period, and long-term survival.

“This innovative cardiac risk assessment tool will greatly improve our ability to provide cell therapy patients with cardiovascular comorbidities with a safer path throughout their treatment, improving their long-term recovery and life. It will have a positive impact on quality,” said co-author John. Maciejewski, MD, a bone marrow transplant physician at UM Health and clinical assistant professor of internal medicine at UM Medical School.