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Cardiology · Haematology

HFA-ICOS Baseline Risk for Multiple Myeloma Therapies calculator

Enter the published formula inputs below to calculate and interpret this score.

Clinical inputs

years

Allowed range: 18–110 years

Quick picks

Age 75 years or older is a high-risk factor. Age 65 through 74 scores 1 point. Under 65 scores 0.

%

Allowed range: 10–80 %

Quick picks

Left ventricular ejection fraction under 50% is a high-risk factor. From 50% through 54% scores 2 points.

mL/min/1.73 m²

Allowed range: 5–160 mL/min/1.73 m²

Quick picks

Estimated GFR under 60 mL/min/1.73 m² scores 1 point.

kg/m²

Allowed range: 12–70 kg/m²

Quick picks

Body mass index above 30 kg/m² scores 1 point. A value of 30 does not.

Heart failure or cardiomyopathy
Prior proteasome-inhibitor cardiotoxicity
Venous thrombosis
Cardiac amyloidosis
Arterial vascular disease

Ischaemic heart disease, coronary stent or bypass, stable angina, transient ischaemic attack, stroke, or peripheral artery disease.

Prior immunomodulatory-drug cardiovascular toxicity
Arrhythmia

Atrial fibrillation, atrial flutter, ventricular tachycardia, or ventricular fibrillation.

Left ventricular hypertrophy

Left ventricular wall thickness above 1.2 cm.

Elevated baseline troponin

Above the upper reference limit of the local laboratory.

Elevated baseline BNP or NT-proBNP

Above the upper reference limit of the local laboratory.

Hypertension

Systolic pressure above 140 mm Hg, diastolic pressure above 90 mm Hg, or treatment for hypertension.

Diabetes mellitus

Glycated haemoglobin above 7.0% or above 53 mmol/mol, or treatment for diabetes.

Hyperlipidaemia

Non-HDL cholesterol above 3.8 mmol/L (above 145 mg/dL).

Family history of thrombophilia
Prior anthracycline
Prior thoracic-spine radiotherapy
High-dose dexamethasone

More than 160 mg per month.

Smoking

Current smoking or a significant smoking history.

Result

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Clinical inputs

  • Age (years)Accepted range: 18 to 110
  • Left ventricular ejection fraction (%)Accepted range: 10 to 80
  • Estimated GFR (mL/min/1.73 m²)Accepted range: 5 to 160
  • Body mass index (kg/m²)Accepted range: 12 to 70
  • Heart failure or cardiomyopathy
  • Prior proteasome-inhibitor cardiotoxicity
  • Venous thrombosis
  • Cardiac amyloidosis
  • Arterial vascular disease
  • Prior immunomodulatory-drug cardiovascular toxicity
  • Arrhythmia
  • Left ventricular hypertrophy
  • Elevated baseline troponin
  • Elevated baseline BNP or NT-proBNP
  • Hypertension
  • Diabetes mellitus
  • Hyperlipidaemia
  • Family history of thrombophilia
  • Prior anthracycline
  • Prior thoracic-spine radiotherapy
  • High-dose dexamethasone
  • Smoking

Primary source

Lyon AR et al. Baseline cardiovascular risk assessment in cancer patients scheduled to receive cardiotoxic cancer therapies: a position statement and new risk assessment tools from the Cardio-Oncology Study Group of the Heart Failure Association of the European Society of Cardiology in collaboration with the International Cardio-Oncology Society. Eur J Heart Fail. DOI: 10.1002/ejhf.1920. PMID: 32463967. Low risk is no risk factor or one medium-1 factor only. Medium risk is medium-risk points totalling 2 to 4. High risk is medium-risk points totalling 5 or more, or any high-risk factor. Very high risk is any very high-risk factor. The same paper gives a guide of under 2%, 2–9%, 10–19%, and 20% or higher for those four levels. The 2022 ESC cardio-oncology guideline (PMID 36017568) directs clinicians to these HFA-ICOS proformas. Table 6, proteasome inhibitors and immunomodulatory agents. Very high: heart failure or cardiomyopathy, prior proteasome-inhibitor cardiotoxicity, venous thrombosis, cardiac amyloidosis, arterial vascular disease. High: prior immunomodulatory-drug cardiovascular toxicity, LVEF under 50%, elevated BNP or NT-proBNP, age 75 years or older, prior anthracycline. Medium 2: LVEF 50–54%, arrhythmia, elevated troponin. Medium 1: left ventricular hypertrophy, age 65–74 years, hypertension, diabetes, hyperlipidaemia, eGFR under 60, family history of thrombophilia, prior thoracic-spine radiotherapy, dexamethasone above 160 mg per month, smoking, BMI above 30. (2020)

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