The new HFA/ICOS risk assessment tool to identify patients with chronic myeloid leukaemia at high risk of cardiotoxicity

Abstract

AimsTyrosine kinase inhibitors (TKIs) used to treat chronic myeloid leukaemia (CML) can cause cardiovascular adverseevents. So far, the Systematic Coronary Risk Evaluation (SCORE) charts of the European Society of Cardiology (ESC) have beenused to identify cancer patients at increased cardiovascular risk. The primary aim of our study was to evaluate the usefulnessof the new cardiovascular risk assessment model proposed by the Cardio-Oncology Study Group of the Heart Failure Associ-ation (HFA) of the ESC in collaboration with the International Cardio-Oncology Society (ICOS) to stratify the cardiovascular riskin CML patients, compared with SCORE risk charts. The secondary aim was to establish the incidence of adverse arterial events(AEs) in patients with CML treated with TKIs and the influence of preventive treatment with aspirin.Methods and resultsA retrospective single-centre observational study was carried out on 58 patients (32 men and 26women; mean age ± SD: 59 ± 15 years) with CML treated with TKIs for a median period of 43 ± 31 months. Cardiological eval-uation was performed and cardiovascular risk was estimated with SCORE risk charts and with the new risk assessment toolproposed by HFA/ICOS. AEs were recorded. According to SCORE charts and the new HFA/ICOS risk stratification tool, respec-tively, 46% (Group A1) and 60% (Group A2) of patients were at high–very high risk, and 54% (Group B1) and 40% (Group B2) atlow–moderate risk. AEs were significantly more frequent in Group A1 than Group B1 (Pvalue<0.01) when considered overall;they were significantly more frequent in Group A2 than Group B2 either overall or considered individually. HFA/ICOS risk strat-ification tool was significantly more sensitive than SCORE (P<0.01) in identifying patients at higher risk of cardiovascular tox-icity. In addition, we did notfind AEs in patients pretreated with aspirin.ConclusionsThe new HFA/ICOS risk stratification model allows a more tailored cardiovascular risk stratification in patientswith CML and it is more sensitive than SCORE charts