Clinical and Genetic Risk Assessment for Overall Survival in Haematopoietic Stem Cell Transplantation (HSCT).

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 1189-1189
Author(s):  
Anne M Dickinson ◽  
Kim F Pearce ◽  
Graham H Jackson ◽  
Matthew Collin ◽  
Jean Norden ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Assessment ◽  
Overall Survival ◽  
Risk Score ◽  
Gene Polymorphisms ◽  
Risk Group ◽  
Clinical Risk Score ◽  
Full Cohort ◽  
Clinical Risk ◽  
Hla Genotyping

Abstract Abstract 1189 Poster Board I-211 Introduction In the last decade, several groups have demonstrated that non-HLA gene polymorphisms can impact on outcome after HSCT. So far, their role appears as a matter of debate; non HLA genotyping is not yet routinely used. In addition, the main clinical factors influencing outcome after HSCT have also been described. Most experience has been gained through analyses of patients undergoing HSCT for chronic myeloid leukemia (CML). Patient age, stage of the disease, time interval from diagnosis to transplant, histocompatibility and donor and patient gender combination were initially identified as key pre-transplant risk factors for CML in the European Group for Blood and Marrow Transplantation (EBMT) clinical risk score, recently confirmed as risk factors for all patients with haematological indications for HSCT. Patients and Methods In this study, we assessed the additional impact of polymorphisms within the tumour necrosis factor receptor II (TNFRSF1B), estrogen receptor (ESR1), vitamin D receptor (VDR), interleukin 6 (IL6), interleukin 1 receptor antagonist (ILRN), interferon gamma (IFNG) and interleukin 4 (IL4) genes on overall survival in a EUROBANK cohort of 915 ( median patient age 41 years, range 16 years to 67 years; 59 % male patients) HLA identical sibling (n=501; 55%) and matched unrelated donor (MUD) (n=414; 45%) transplants consisting of patients having either acute leukaemia (AL) (n=463; 51%), CML (N=187; 20%), plasma cell neoplasia (n=120; 13%) or lymphoma (n=145; 16%) from 8 transplant centres (Barcelona, Paris, Munich, Newcastle-upon-Tyne, Prague, Regensburg, Vienna and Rostock). The statistical analysis was performed for the full cohort and for the AL subgroup. Potential influential genetic factors were assessed using the log rank test (p value < 0.2). These candidate factors were further included in addition to the EBMT clinical risk score in a stepwise Cox regression procedure to select final genes. The power of a model to predict overall survival was assessed through prediction error curves. Results For the full cohort, the SNP IL6−174 within the IL6 gene in donors improved the prediction of the outcome by EBMT clinical risk score. Specifically, the presence of allele C in the donor IL-6 genotype was associated with lower survival time. This SNP assessment only held true for the (combined) CML, lymphoma and plasma cell neoplasia subgroups (log rank, p=0.016), not for AL (log rank, p= 0.638). The AL subgroup, the largest, was further assessed separately. Absence of patient IL4 (any T) and presence of patient IL1RN (any C) were associated with lower survival time as shown by Kaplan Meier survival plots. When viewed together with the EBMT score, these two genotypes improved the predictive value. Patients with absence of patient IL4 (any T) and presence of patient IL1RN (any C) were assigned to the ‘high risk’ group; remaining patients were assigned to the low risk group - Figure 1A and B illustrate the lower probability of survival and higher incidence of transplant related mortality (TRM) in the high risk polymorphism AL group compared with the low risk group. Conclusions This study confirms the important role of non-HLA genotyping for risk assessment in allogeneic HSCT. Improvement of fit of the EBMT risk score presents a powerful novel tool to assess this impact of cytokine gene polymorphisms in a complex heterogeneous patient population such as HSCT. Disclosures No relevant conflicts of interest to declare.

scholarly journals Expression profiling analysis of autophagy-related genes in cervical cancer

2021 ◽  
Author(s):  
Zhiyuan Huang ◽  
He Wang ◽  
Min Liu ◽  
Xinrui Li ◽  
Lei Zhu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cervical Cancer ◽  
Overall Survival ◽  
Risk Score ◽  
Roc Curve ◽  
Normal Tissue ◽  
Cox Regression ◽  
Risk Group ◽  
Differentially Expressed ◽  
Tissue Samples

Abstract Background: It has been demonstrated by studies globally that autophagy took part in the development of cervical cancer (CC). Few studies concentrated on the correlation between overall survival and CC patients. We retrieved significant autophagy-related genes (ARGs) correlated to the process of cervical cancer. They may be used as prognosis marker or treatment target for clinical application.Methods: Expressions level of genes in cervical cancer and normal tissue samples were obtained from GTEx and TCGA database. Autophagy-related genes (ARGs) were retrieved accroding to the gene list from HaDB. Differentially expressed autophagy related genes (DE-ARGs) related to cervical cancer were identified by Wilcoxon signed-rank test. ClusterProfiler package worked in R software was used to perform GO and KEGG enrichment analyses. Univariate propotional hazard cox regression and multivariate propotional hazard cox regressions were applied to identify DE-ARGs equipped with prognostic value and other clinical independent risk factors. ROC curve was drawn for comparing the survival predict feasibility of risk score with other risk factors in CC patients. Nomogram was drawn to exhibit the prediction model constructed accroding to multivariate cox regression. Correlations between Differentially expressed autophagy related genes (DE-ARGs) and other clinical features were investigated by t test or Cruskal wallis analysis. Correlation between Immune and autophagy in cervical cancer was investigated by ssGSEA and TIMER database. Results: Fifty-six differentially expressed ARGs (DE-ARGs) were retrieved from cervical cancer tissue and normal tissue samples. GO enrichment analysis showed that these ARGs involved in autophagy, ubiquitination of protein and apoptosis. Cox regression medel showed that there were six ARGs significantly associated with overall survival of cervical caner patients. VAMP7 (HR = 0.599, P= 0.033) and TP73 (HR = 0.671, P= 0.014) played protective roles in survival among these six genes. Stage (Stage IV vs Stage I HR = 3.985, P<0.001) and risk score (HR = 1.353, P< 0.001) were sorted as independent prognostic risk factors based on multivariate cox regression. ROC curve validated that risk score was preferable to predict survival of CC patients than other risk factors. Additionally, we found some of these six predictor ARGs were correlated significantly in statistic with tumor grade or stage, clinical T stage, clinical N stage, pathology or risk score (all P< 0.05). The immune cells and immune functions showed a lower activity in high risk group than low risk group which is distincted by median risk score. Conclusion: Our discovery showed that autophagy genes involved in the progress of cervical cancer. Many autophagy-related genes could probably serve as prognostic biomarkers and accelerate the discovery of treatment targets for CC patients.

Abstract 2311: Clinical Predictors Of Survival In Heart Failure Patients Following Cardiac Resynchronization Therapy

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Daniel M Couri ◽  
Grace Lin ◽  
Tracy L Webster ◽  
Peter A Brady
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Multivariate Analysis ◽  
Cardiac Resynchronization Therapy ◽  
Risk Score ◽  
Ischemic Cardiomyopathy ◽  
Cardiac Resynchronization ◽  
Clinical Risk Score ◽  
Resynchronization Therapy ◽  
Clinical Risk

Introduction: Appropriate selection of patients (pts) with heart failure (HF) who may benefit from cardiac resynchronization therapy (CRT) is difficult. We sought to identify a clinical risk score to better risk stratify patients prior to CRT implantation. Methods: Pts undergoing CRT at Mayo Clinic from 2000 –2005 were included. Multiple clinical variables (age, gender, anemia (Hgb <10g/dL), RF (creatinine clearance ≤ 60ml/min/1.73m 2 ), hyponatremia (Na ≤130mEq/L), elevated BNP level (>500pg/ml), etiology, EF ≤20%, and advanced HF (NYHA functional class III–IV) were assessed with outcomes following CRT. Multivariate analysis was used to determine a clinical risk score. Results: A total of 496 patients (80% males) age 68 ± 12 years (62% ischemic cardiomyopathy, EF 22% ± 8%) were included. In univariate analysis relative risk (RR) was > 1 for RF (RR 1.8, CI 1.3–2.8; p = 0.002), anemia (RR 3.3, CI 1.8 –5.5; p = 0.001), hyponatremia (RR 3.4, CI 1.4 – 6.9; p = 0.008), elevated BNP (RR 2.9, CI 1.6 –5.7; p < 0.001), ischemic cardiomyopathy (ICM) (RR 1.8, CI 1.2–2.7; p < 0.002), EF ≤ 20% (RR 1.5, CI 1.0 –2.1; p = 0.033), and advanced HF (RR 2.5, CI 1.5– 4.9; p < 0.001). Following multivariate analysis RF, anemia, ICM, and advanced HF remained significant predictors of poor outcome (p >0.01 for all). Survival with 3 or more of these clinical risk factors was significantly worse than with less risk factors (p <0.01, Figure ). Conclusions: Pre-implant clinical risk factors including anemia, RF, ICM and advanced HF predict worse outcome following CRT with ≥3 variables predicting >2-fold increased risk of death or heart transplantation. These factors should be considered when selecting pts prior to CRT.

P5642A clinical risk score for estimating sudden cardiac death risk in the general population

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A Aro ◽  
A Holkeri ◽  
A Eranti ◽  
T Kerola ◽  
M J Junttila ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Risk ◽  
General Population ◽  
Cardiovascular Risk Factors ◽  
Risk Score ◽  
Clinical Risk Score ◽  
Clinical Risk ◽  
All Cause Mortality ◽  
Male Sex

Abstract Background Sudden cardiac death (SCD) remains a major cause of premature mortality worldwide, so there has been an ongoing pursuit for tools for SCD risk stratification. Coronary artery disease is the major cause for SCD in adults, but the level of risk associated with multiple cardiovascular risk factors is not well established. Purpose To create a clinical risk score for estimating SCD risk in the general population. Methods Using data from a Finnish general population cohort of 7200 adults (mean age 51y, 46% male) with a mean follow-up of 24±11 years, we assessed the incremental SCD risk associated with the presence of several cardiovascular risk factors. SCD events were adjudicated based on death certificates according to the established criteria (autopsy was performed on 48% of SCD cases). Hazard ratios (HR) for SCD and all-cause mortality were calculated using the Cox proportional hazards model. Of the multiple parameters analysed, male sex, increasing age, diabetes, hypertension, smoking and previously diagnosed cardiac disease were independently associated with SCD in a multivariable model. Based on the magnitude of risk, a SCD risk score was created (2 points: age >70y; 1 point: male sex, age 60–70y, diabetes, hypertension, smoking, cardiac disease). Results 75.2% of the study subjects had 0–2 risk points, 12.8% 3 risk points, and 12.0% >3 risk points. During the follow-up, 400 SCDs occurred. Increasing risk score was associated with a progressively greater risk for SCD (Figure). Compared with subjects without risk factors, those with a risk score of 3 had a HR of 21.2 (95% CI 12.7–35.4, p<0.001) and those with a risk score of >3 had a HR of 52.6 (95% CI 31.3–88.3, p<0.001) for SCD. Clinical risk score predicted significantly also all-cause mortality (HR 31.5 with risk score >3 [95% CI 27.6–35.9, p<0.001]). Risk of SCD according to the risk score Conclusions Accumulation of multiple cardiovascular risk factors is associated with a markedly elevated risk for SCD in the general population. This highlights the need for SCD prevention efforts with lifestyle interventions and medical therapy in the high-risk subjects. Studies on focused SCD risk stratification may be warranted in the subjects at highest risk.

scholarly journals A methylation-based nomogram for predicting survival in patients with lung adenocarcinoma

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Xuelong Wang ◽  
Bin Zhou ◽  
Yuxin Xia ◽  
Jianxin Zuo ◽  
Yanchao Liu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Dna Methylation ◽  
Overall Survival ◽  
Regression Analysis ◽  
Lung Adenocarcinoma ◽  
Risk Score ◽  
Cox Regression ◽  
Risk Group ◽  
Clinical Risk Factors ◽  
Cox Regression Analysis

Abstract Background DNA methylation alteration is frequently observed in Lung adenocarcinoma (LUAD) and may play important roles in carcinogenesis, diagnosis, and prognosis. Thus, this study aimed to construct a reliable methylation-based nomogram, guiding prognostic classification screening and personalized medicine for LUAD patients. Method The DNA methylation data, gene expression data and corresponding clinical information of lung adenocarcinoma samples were extracted from The Cancer Genome Atlas (TCGA) database. Differentially methylated sites (DMSs) and differentially expressed genes (DEGs) were obtained and then calculated correlation by pearson correlation coefficient. Functional enrichment analysis and Protein-protein interaction network were used to explore the biological roles of aberrant methylation genes. A prognostic risk score model was constructed using univariate Cox and LASSO analysis and was assessed in an independent cohort. A methylation-based nomogram that included the risk score and the clinical risk factors was developed, which was evaluated by concordance index and calibration curves. Result We identified a total of 1362 DMSs corresponding to 471 DEGs with significant negative correlation, including 752 hypermethylation sites and 610 hypomethylation sites. Univariate cox regression analysis showed that 59 DMSs were significantly associated with overall survival. Using LASSO method, we constructed a three-DMSs signature that was independent predictive of prognosis in the training cohort. Patients in high-risk group had a significant shorter overall survival than patients in low-risk group classified by three-DMSs signature (log-rank p = 1.9E-04). Multivariate cox regression analysis proved that the three-DMSs signature was an independent prognostic factor for LUAD in TCGA-LUAD cohort (HR = 2.29, 95%CI: 1.47–3.57, P = 2.36E-04) and GSE56044 cohort (HR = 2.16, 95%CI: 1.19–3.91, P = 0.011). Furthermore, a nomogram, combining the risk score with clinical risk factors, was developed with C-indexes of 0.71 and 0.70 in TCGA-LUAD and GSE56044 respectively. Conclusions The present study established a robust three-DMSs signature for the prediction of overall survival and further developed a nomogram that could be a clinically available guide for personalized treatment of LUAD patients.

scholarly journals Clinical Risk Score for the Prediction of Incident Atrial Fibrillation: Derivation in 7 220 654 Taiwan Patients With 438 930 Incident Atrial Fibrillations During a 16‐Year Follow‐Up

2021 ◽  
Author(s):  
Tze‐Fan Chao ◽  
Chern‐En Chiang ◽  
Tzeng‐Ji Chen ◽  
Jo‐Nan Liao ◽  
Ta‐Chuan Tuan ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
High Risk ◽  
Risk Score ◽  
Risk Group ◽  
Low Risk ◽  
Intermediate Risk ◽  
Clinical Risk Score ◽  
Clinical Risk ◽  
Asian Patients

Background Although several risk schemes have been proposed to predict new‐onset atrial fibrillation (AF), clinical prediction models specific for Asian patients were limited. In the present study, we aimed to develop a clinical risk score (Taiwan AF score) for AF prediction using the whole Taiwan population database with a long‐term follow‐up. Methods and Results Among 7 220 654 individuals aged ≥40 years without a past history of cardiac arrhythmia identified from the Taiwan Health Insurance Research Database, 438 930 incident AFs occurred after a 16‐year follow‐up. Clinical risk factors of AF were identified using Cox regression analysis and then combined into a clinical risk score (Taiwan AF score). The Taiwan AF score included age, male sex, and important comorbidities (hypertension, heart failure, coronary artery disease, end‐stage renal disease, and alcoholism) and ranged from −2 to 15. The area under the receiver operating characteristic curve of the Taiwan AF scores in the predictions of AF are 0.857 for the 1‐year follow‐up, 0.825 for the 5‐year follow‐up, 0.797 for the 10‐year follow‐up, and 0.756 for the 16‐year follow‐up. The annual risks of incident AF were 0.21%/year, 1.31%/year, and 3.37%/year for the low‐risk (score −2 to 3), intermediate‐risk (score 4 to 9), and high‐risk (score ≥10) groups, respectively. Compared with low‐risk patients, the hazard ratios of incident AF were 5.78 (95% CI, 3.76–7.75) for the intermediate‐risk group and 8.94 (95% CI, 6.47–10.80) for the high‐risk group. Conclusions We developed a clinical AF prediction model, the Taiwan AF score, among a large‐scale Asian cohort. The new score could help physicians to identify Asian patients at high risk of AF in whom more aggressive and frequent detections and screenings may be considered.

scholarly journals A Methylation-based nomogram for predicting survival in patients with lung adenocarcinoma

2020 ◽  
Author(s):  
Xuelong Wang ◽  
Bin Zhou ◽  
Yuxin Xia ◽  
Jianxin Zuo ◽  
Yanchao Liu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Dna Methylation ◽  
Overall Survival ◽  
Regression Analysis ◽  
Lung Adenocarcinoma ◽  
Risk Score ◽  
Cox Regression ◽  
Risk Group ◽  
Clinical Risk Factors ◽  
Cox Regression Analysis

Abstract Background DNA methylation alteration is frequently observed in Lung adenocarcinoma (LUAD) and may play important roles in carcinogenesis, diagnosis, and prognosis. Thus, this study aimed to construct a reliable methylation-based nomogram, guiding prognostic classification screening and personalized medicine for LUAD patients. Method: The DNA methylation data, gene expression data and corresponding clinical information of lung adenocarcinoma samples were extracted from The Cancer Genome Atlas (TCGA) database. Differentially methylated sites (DMSs) and differentially expressed genes (DEGs) were obtained and then calculated expression correlation by pearson correlation coefficient. Functional enrichment analysis and Protein-protein interaction network were used to explore the biological roles of aberrant methylation genes. A prognostic risk score model was constructed using univariate Cox and LASSO analysis and was assessed in an independent cohort. A methylation-based nomogram that included the risk score and the clinical risk factors was developed, which was evaluated by concordance index and calibration curves. Result We identified a total of 1362 DMSs corresponding to 471 DEGs with significant negative correlation, including 752 hypermethylation sites and 610 hypomethylation sites. Univariate cox regression analysis showed that 59 DMSs were significantly associated with overall survival. Using LASSO method, we constructed a three-DMSs signature that was independent predictive of prognosis in the training cohort. Patients in high-risk group had a significant shorter overall survival than patients in low-risk group classified by three-DMSs signature (log-rank p = 1.9E-04). Multivariate cox regression analysis proved that the three-DMSs signature was an independent prognostic factor for LUAD in TCGA-LUAD cohort (HR = 2.29, 95%CI: 1.47–3.57, P = 2.36E-04) and GSE56044 cohort (HR = 2.16, 95%CI: 1.19–3.91, P = 0.011). Furthermore, a nomogram, combining the risk score with clinical risk factors, was developed with C-indexes of 0.71 and 0.70 in TCGA-LUAD and GSE56044 respectively. Conclusions The present study established a robust three-DMSs signature for the prediction of overall survival and further developed a nomogram that could be a clinically available guide for personalized treatment of LUAD patients.

scholarly journals Comparative risk assessment for the development of cardiovascular diseases in the Hungarian general and Roma population

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Peter Piko ◽  
Zsigmond Kosa ◽  
Janos Sandor ◽  
Roza Adany
Keyword(s):  
Risk Factors ◽  
Risk Assessment ◽  
Cardiovascular Risk ◽  
Cardiovascular Diseases ◽  
High Risk ◽  
Risk Group ◽  
High Risk Group ◽  
Average Risk ◽  
Cvd Risk ◽  
Roma Population

AbstractCardiovascular diseases (CVDs) are the number one cause of death globally, and the early identification of high risk is crucial to prevent the disease and to reduce healthcare costs. Short life expectancy and increased mortality among the Roma are generally accepted (although not indeed proven by mortality analyses) which can be partially explained by the high prevalence of cardiovascular risk factors (CVRF) among them. This study aims to elaborate on the prevalence of the most important CVD risk factors, assess the estimation of a 10-year risk of development of fatal and nonfatal CVDs based on the most used risk assessment scoring models, and to compare the Hungarian general (HG) and Roma (HR) populations. In 2018 a complex health survey was accomplished on the HG (n = 380) and HR (n = 347) populations. The prevalence of CVRS was defined and 10-year cardiovascular risk was estimated for both study populations using the following systems: Framingham Risk Score for hard coronary heart disease (FRSCHD) and for cardiovascular disease (FRSCVD), Systematic COronary Risk Evaluation (SCORE), ACC/AHA Pooled Cohort Equations (PCE) and Revised Pooled Cohort Equations (RPCE). After the risk scores had been calculated, the populations were divided into risk categories and all subjects were classified. For all CVD risk estimation scores, the average of the estimated risk was higher among Roma compared to the HG independently of the gender. The proportion of high-risk group in the Hungarian Roma males population was on average 1.5–3 times higher than in the general one. Among Roma females, the average risk value was higher than in the HG one. The proportion of high-risk group in the Hungarian Roma females population was on average 2–3 times higher compared to the distribution of females in the general population. Our results show that both genders in the Hungarian Roma population have a significantly higher risk for a 10-year development of cardiovascular diseases and dying from them compared to the HG one. Therefore, cardiovascular interventions should be focusing not only on reducing smoking among Roma but on improving health literacy and service provision regarding prevention, early recognition, and treatment of lipid disorders and diabetes among them.

scholarly journals The CUORE project cardiovascular risk assessment in primary care: the ongoing experience in Italy

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
L Palmieri ◽  
S Vannucchi ◽  
C Lo Noce ◽  
A Di Lonardo ◽  
B Unim ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Risk Assessment ◽  
Primary Care ◽  
Cardiovascular Risk ◽  
Risk Score ◽  
Adult Population ◽  
Cardiovascular Risk Assessment ◽  
Project Risk ◽  
Preventive Actions

Abstract Background Italian National Prevention Plan 2005-08 included 10-year cardiovascular risk assessment (10-CR) for the general population aged 35-69 years using the CUORE Project risk score. GPs were encouraged to perform 10-CR and send data to the Cardiovascular Risk Observatory (CRO). Aim To show updated data of the ongoing surveillance system of the 10-CR in the Italian adult population. Methods Data were collected using the cuore.exe software, freely downloadable by GPs from the CUORE Project website (www.cuore.iss.it). The CRO provides a web-platform to compare data on 10-CR and risk factors at regional/national level. For persons examined at least twice, variations in risk factors from baseline to follow-up and 95% confidence intervals (C.I.) were calculated using methods for matched pair samples. Results Up to February 2019, about 3,500 GPs downloaded cuore.exe; about 300,000 CR assessments on about 140,000 persons were sent to CRO. Mean CR was 3.1% in women (W), 8.5% in men (M); 28% of M, 64% of W were at low risk (CR &lt; 3%); 9.9% of M, 0.4% of W were at high risk (CR ≥ 20%); 26% of M, 16% of W were current smokers; 13% of M, 10% of W were diabetic; 33% of hypertensive M, 35% of hypertensive W were under specific treatment. Among those with at least two risk assessments (31% of the sample), 11% shifted to a lower risk class after one year (14% of M, 7% of W). Systolic blood pressure mean levels decreased by 0.6 mmHg (95%-C.I. 0.3-0.8 mmHg), diastolic blood pressure by 0.5 mmHg (0.2-0.7 mmHg), total cholesterol by 4.1 mg/dl (3.0-5.2 mg/dl), smokers prevalence by 3.1% (2.3%-4.0%); HDL-cholesterol increased in W by 0.3 mg/dl (0.1-0.5 mg/dl). Conclusions Data demonstrate that 10-CR assessment can be an effective first step to implement preventive actions in primary care. Individual risk score is a useful tool for GPs to assess CR and promote primary prevention focusing on the adoption of healthy lifestyles. Data can be used to support health policy decision process. Key messages The cuore.exe software, freely downloadable from the CUORE Project website-www.cuore.iss.it, allows GPs to assess the CUORE Project risk score, to collect and to send data to the CVD Risk Observatory. 10 year Cardiovascular Risk assessment in the general adult population can be an effective first step to implement preventive actions in primary care.

scholarly journals Multiple Myeloma Patients Undergoing Carfilzomib: Development and Validation of a Risk Score for Cardiovascular Adverse Events Prediction

Cancers ◽  
2021 ◽  
Vol 13 (7) ◽  
pp. 1631
Author(s):  
Anna Astarita ◽  
Giulia Mingrone ◽  
Lorenzo Airale ◽  
Fabrizio Vallelonga ◽  
Michele Covella ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Risk Assessment ◽  
Multiple Myeloma ◽  
Cardiovascular Risk ◽  
High Risk ◽  
Adverse Events ◽  
Risk Score ◽  
Risk Group ◽  
High Risk Group ◽  
Cardiovascular Risk Assessment

Cardiovascular adverse events (CVAEs) are linked to Carfilzomib (CFZ) therapy in multiple myeloma (MM); however, no validated protocols on cardiovascular risk assessment are available. In this prospective study, the effectiveness of the European Myeloma Network protocol (EMN) in cardiovascular risk assessment was investigated, identifying major predictors of CVAEs. From January 2015 to March 2020, 116 MM patients who had indication for CFZ therapy underwent a baseline evaluation (including blood pressure measurements, echocardiography and arterial stiffness estimation) and were prospectively followed. The median age was 64.53 ± 8.42 years old, 56% male. Five baseline independent predictors of CVAEs were identified: office systolic blood pressure, 24-h blood pressure variability, left ventricular hypertrophy, pulse wave velocity value and global longitudinal strain. The resulting ‘CVAEs risk score’ distinguished a low- and a high-risk group, obtaining a negative predicting value for the high-risk group of 90%. 52 patients (44.9%) experienced one or more CVAEs: 17 (14.7%) had major and 45 (38.7%) had hypertension-related events. In conclusion, CVAEs are frequent and a specific management protocol is crucial. The EMN protocol and the risk score proved to be useful to estimate the baseline risk for CVAEs during CFZ therapy, allowing the identification of higher-risk patients.

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