Abstract 14681: Coronary Artery Calcium is Associated With Cardiovascular Disease and Poorer Survival in Patients Undergoing Autologous Hematopoietic Cell Transplantation

Abstract

Background: Hematopoietic cell transplantation (HCT) is an established curative treatment for patients with hematologic malignancies, however survivors are at a >4-fold risk of cardiovascular disease ([CVD] heart failure, myocardial infarction, stroke]) compared to the general population. Coronary artery calcium (CAC) is predictive of CVD in non-oncology patients; less is known about its association with CVD risk and outcomes after HCT. Methods: This was a retrospective cohort study of 243 consecutive patients who underwent first autologous HCT for Hodgkin/non-Hodgkin lymphoma between 2009-2014 with no history of CVD. CAC was determined from chest computed tomography performed <60d from HCT; measurements (Agatston unit) were made by trained researchers blinded to patient demographics and outcomes. CAC was categorized as: 0, 1-100, >100. Multivariable Cox regression analysis was used to calculate hazard ratio (HR) estimates and 95% confidence intervals (CI), adjusted for covariates (age, conventional risk factors [e.g. hypertension, dyslipidemia], cancer treatment). Results: Median age (range) at HCT was 55.7y (18.5y-75.1y), 59% were male; race/ethnicity: non-Hispanic white (60%), Hispanic (25%), Asian (11%), Black (4%); prevalence of CAC was 37%. The 5y CVD incidence for the cohort was 12%, and there was an incremental increase according to CAC score: 0 (6%), 1-100 (20%), >100 (32%); p=0.001 (Figure 1A). CAC was significantly associated with CVD risk (HR 3.0, 95%CI 1.2-7.5) and worse 5y survival (77% vs. 50% p<0.001 [Figure 1B]; HR 2.0, 95%CI 1.1-3.4), compared to those without CAC. Conclusions: CAC is an important and independent predictor of CVD and survival after HCT. Taken together, these data form the basis for integration of readily available imaging information into decision making prior to HCT (e.g. pre-habilitation, non-HCT approaches) or after HCT (e.g. cardiac rehabilitation), setting the stage for strategies to optimize outcomes after HCT.