External Validation of the CARE-BMT and Modified CARE-BMT Scores for Cardiac Event Prediction After Allogeneic Hematopoietic Cell Transplantation in Acute Myeloid Leukemia.

Abstract

Background: Cardiac events after allogeneic hematopoietic cell transplantation (allo-HCT) are associated with increased non-relapse mortality (NRM) and inferior survival. The CARE-BMT score predicts cardiovascular events after hematopoietic cell transplantation but does not incorporate post-transplant cyclophosphamide (PTCy). We aimed to externally validate the original CARE-BMT score and a modified version incorporating standard-dose PTCy exposure in patients with acute myeloid leukemia (AML) undergoing allo-HCT.

Methods: We conducted a retrospective multicenter study including 809 adults with AML who underwent first allo-HCT across 11 Spanish transplant centers. The original and modified CARE-BMT scores were retrospectively applied. The primary endpoint was the cumulative incidence of post-transplant cardiac events, with relapse and death considered competing risks.

Results: Sixty patients developed a cardiac event, corresponding to a cumulative incidence of 6.9% (95% CI, 5.2-8.8). Cardiac events were associated with inferior 3-year overall survival (50.1% vs 62.5%; P = 0.001) and higher 3-year NRM (21.3% vs 6.2%; P = 0.001). Using the original CARE-BMT score, patients were classified as intermediate-risk (n = 246) or high-risk (n = 563), with no low-risk patients identified. Cardiac event incidence was higher in the high-risk group (8.6% vs 3.0%; HR, 2.89; P = 0.005). The modified CARE-BMT score classified patients as low-risk (n = 85), intermediate-risk (n = 558), or high-risk (n = 166), with progressively increasing cardiac event incidence (2.4%, 6.1%, and 11.8%, respectively; P = 0.011). High-risk patients had a significantly greater risk of cardiac events than low-risk patients (HR, 5.37; P = 0.024).

Conclusions: In this AML allo-HCT cohort, cardiac events occurred in approximately 7% of patients and were associated with worse survival and increased NRM. Incorporating standard-dose PTCy improved risk stratification, supporting inclusion of transplant-specific variables in cardiovascular risk prediction after allo-HCT.