Novel Tool Predicts Cardiovascular Risks after Bone Marrow Transplantation

Every year, thousands of people undergo bone marrow transplants to potentially cure serious diseases like leukemia, lymphoma, and immune deficiency disorders. While these transplants can be lifesaving, they also pose risks to various organs, including the heart and blood vessels. Medical advancements have allowed for these transplants to be offered to older individuals, who are at a higher risk for cardiovascular issues. Now, researchers have both identified the current rates of heart-related complications following bone marrow transplants as well as created a new tool to predict an individual's risk for such issues and guide the pre-transplant process.

Researchers led by Michigan Medicine (Ann Arbor, MI, USA) built the Cardiovascular Registry in Bone Marrow Transplantation, known as CARE-BMT, which compiles data of patients who underwent transplants. Their research, which looked at over 3,300 patients from 2008 to 2019, found that 4.1% had cardiovascular events within 100 days post-transplant, and 13.9% experienced such events within five years. Although cardiovascular problems during the hospital stay were uncommon, the most frequent conditions over time were atrial fibrillation, seen in 6.8% of patients by the five-year mark, and heart failure, experienced in 5.4% of patients. Serious complications like heart attacks and strokes were rare.

The study revealed that 16.4% of patients receiving bone marrow from a donor faced long-term cardiovascular events within five years, in contrast to 12.1% of patients who received their own stem cells. Those with existing heart conditions, including diabetes and coronary artery disease, had a higher chance of long-term complications, though not during the transplant itself. Using CARE-BMT data, the researchers devised a simple, points-based risk score based on readily available clinical information such as age, race, history of coronary artery disease or heart failure, and previous exposure to heart-damaging chemotherapy. This risk score, called the CARE-BMT risk score, was able to identify a high-risk group that represented over 30% of the study participants. In this group, the rate of cardiovascular complications was 31.9% at five years, increasing to 55% at ten years. The score was effective in predicting risk for both donor and self-derived bone marrow transplant recipients and was validated in a separate group of over 900 patients.

“In the early era of bone marrow transplant, patients with heart disease were often excluded due to the cardiotoxicity of the conditioning regimens used at the time,” said Salim Hayek, M.D., adjunct professor of internal medicine-cardiology at U-M Medical School who specializes in cardio-oncology. “Understanding the cardiovascular risks of modern bone marrow transplantation is crucial for selecting the right patients and to ensure that none are excluded unnecessarily. This is the first contemporary evidence that shows the risks associated with bone marrow transplant and how to assess a patient’s risk for cardiovascular complications— which, taken together, can guide clinicians to ensure better outcomes for this procedure.”

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