Evaluating the cardiovascular risk profiles of multiple myeloma patients before and 1 year after autologous stem cell transplant

Background

Transplant-eligible multiple myeloma (TEMM) patients undergoing autologous stem cell transplant (ASCT) are at elevated risk of cardiovascular (CV) events. Several CV risk stratification tools are used in practice, yet their applicability and concordance in this population remain uncertain, and real-world CV risk factor management is poorly characterised.

Purpose

To characterise baseline CV risk profiles in TEMM patients using commonly used risk tools, and to evaluate CV risk factor assessment and control before and one year after ASCT.

Methods

We conducted a multi-site retrospective cohort study of consecutive TEMM patients undergoing ASCT between October 2022 and April 2025. Baseline CV risk was assessed using the validated CARE-BMT score and compared with the unvalidated HFA-ICOS baseline CV risk assessment tool, and the global CV outcomes Framingham Risk Score (FRS). Secondary outcomes included completeness of CV risk factor assessment, control of modifiable risk factors at baseline and one-year post-ASCT, and CV events within one year.

Results

Among the 160 included patients (median age 58 years; 59.4% male), 80.6% had ≥1 modifiable CV risk factor at baseline. CARE-BMT classified most patients as intermediate risk (63.8%), HFA-ICOS as high or very high-risk (42.5%) and FRS as high risk (42.7%). At baseline, prior to transplant, all patients had blood pressure measurements and 98.8% underwent echocardiography; however, key laboratory assessments were frequently missing. Lipid panels, HbA1c, and lipoprotein(a) were absent in 24.3%, 21.9%, and 96.9% of patients, respectively. In those with risk factors, control was variable with no individual risk factor achieving >60% control (Figure 2a).

Of the 97 patients with one-year post-ASCT follow-up, 81.4% had blood pressure measurements, 43.3% had HbA1c testing, and 46.4% had lipid panels at one year. Control of modifiable risk factors remained suboptimal (Figure 2b). Seven patients (4.4%) experienced a CV event within one year, all due to new-onset atrial fibrillation/flutter, occurring a median of 13 days post-transplant.

Conclusion

Marked discordance exists between validated and unvalidated CV risk stratification tools in TEMM patients, highlighting potential limitations of applying non-validated models in this setting. Substantial gaps in CV risk assessment and longitudinal risk factor control underscore the need for structured, multidisciplinary cardio-oncology pathways to support surveillance and preventive care before and after ASCT.