Department of Population Sciences and.
Department of Information Sciences, City of Hope, Duarte, CA.
Blood Adv. 2018 Jul 24;2(14):1756-1764. doi: 10.1182/bloodadvances.2018019117.
Cardiovascular disease (CVD) is a leading cause of late morbidity and mortality in hematopoietic cell transplantation (HCT) survivors. HCT-specific CVD risk prediction models are needed to facilitate early screening and prevention. In the current study, patients who underwent HCT at City of Hope (COH) and survived 1-year free of clinically evident CVD (N = 1828) were observed for the development of heart failure (HF) or coronary artery disease (CAD) by 10-years from index date (1 year from HCT). CVD occurred in 135 individuals (92 HF, 43 CAD). Risk prediction models were developed for overall CVD (HF and/or CAD) using COH-derived integer risk scores. Risk scores based on selected variables (age, anthracycline dose, chest radiation, hypertension, diabetes, smoking) achieved an area under the curve (AUC) and concordance (C) statistic of 0.74 and 0.72 for CVD; these varied from 0.70 to 0.82 according to CVD subtype (HF or CAD). A Fred Hutchinson Cancer Research Center case cohort (N = 580) was used to validate the COH models. Validation cohort AUCs ranged from 0.66 to 0.75. Risk scores were collapsed to form statistically distinct low-, intermediate-, and high-risk groups, corresponding to 10-year cumulative incidences of CVD of 3.7%, 9.9%, and 26.2%, respectively. Individuals in the high- and intermediate-risk groups were at 7.8-fold (95% confidence interval, 5.0-12.2) and 2.9-fold (95% confidence interval, 1.9-4.6) risk of developing CVD (referent group: low risk). These validated models provide a framework on which to modify current screening recommendations and for the development of targeted interventions to reduce the risk of CVD after HCT.
心血管疾病（CVD）是造血细胞移植（HCT）幸存者晚期发病率和死亡率的主要原因。需要 HCT 特异性 CVD 风险预测模型来促进早期筛查和预防。在目前的研究中，观察了在希望之城（COH）接受 HCT 且在 1 年内无临床明显 CVD（N = 1828）的患者，以从索引日期（HCT 后 1 年）起 10 年内发生心力衰竭（HF）或冠状动脉疾病（CAD）。共有 135 名患者（92 例 HF，43 例 CAD）发生 CVD。使用 COH 衍生的整数风险评分开发了用于总体 CVD（HF 和/或 CAD）的风险预测模型。基于选定变量（年龄、蒽环类药物剂量、胸部放疗、高血压、糖尿病、吸烟）的风险评分获得了 CVD 的曲线下面积（AUC）和一致性（C）统计量为 0.74 和 0.72；根据 CVD 亚型（HF 或 CAD），这些值在 0.70 到 0.82 之间变化。弗雷德哈钦森癌症研究中心的病例队列（N = 580）用于验证 COH 模型。验证队列的 AUC 范围为 0.66 至 0.75。风险评分被合并为统计学上不同的低、中、高危组，相应的 10 年 CVD 累积发生率分别为 3.7%、9.9%和 26.2%。高危组和中危组个体发生 CVD 的风险分别为低危组的 7.8 倍（95%置信区间，5.0-12.2）和 2.9 倍（95%置信区间，1.9-4.6）。这些经过验证的模型为修改当前筛查建议和开发针对 HCT 后降低 CVD 风险的靶向干预措施提供了框架。
