Implementation of hfa-icos risk score in patients with non-hodgkin lymphoma undergoing non-pegylated doxorubicin therapy
M Camilli, I Torre, L Leo, M Viscovo, S Hohaus, F Burzotta, A Lombardo, G MinottiAbstract
Background
Elderly patients with non-Hodgkin lymphoma, or patients with pre-existing cardiovascular comorbidities, are frequently treated with chemotherapy regimens containing non-PEGylated liposomal anthracycline, in order to reduce cardiotoxicity incidence. For patients candidate to anthracycline, the 2022 European Society of Cardiology (ESC) cardio-oncology guidelines recommend risk stratification through established proformas, but their real-world validation for patients candidate to liposomal anthracycline remains limited.
Methods
We retrospectively collected data on patients with newly diagnosed non-Hodgkin lymphoma treated with rituximab, cyclophosphamide, non-PEGylated doxorubicin, vincristine, and prednisone (R-COMP) between 2014 and 2025. Baseline demographics, cardiovascular history, echocardiographic and laboratory parameters, and baseline therapy were recorded. Patients were stratified into risk categories according to the Heart Failure Association International Cardio-Oncology Society (HFA-ICOS) score. Outcomes included overall survival (OS), cardiovascular events occurrence (including asymptomatic left ventricular dysfunction, new-onset or worsening heart failure and acute coronary syndrome) and progression-free survival (PFS).
Results
The cohort consisted of 265 patients [median age 73 years (69 – 77); 51% males]; 41% were classified as moderate risk, 55% as high risk, and 4% as very high risk. During a median follow-up of 29 months, 38 patients (14%) died. OS and cardiovascular events occurrence significantly differed across HFA-ICOS risk categories (p=0.005 and p<0.0001, respectively). Very high-risk patients exhibited substantially higher hazards of mortality (HR 5.8) and cardiovascular events (HR 40.4). Cardioprotective therapy at baseline did not influence cardiovascular outcomes.
Conclusions
The HFA-ICOS score effectively stratifies mortality and cardiotoxicity risk among R-COMP–treated patients. These findings support its application in routine treatment of lymphomas requiring anthracycline-based therapy.