Prognostic value of HFA-ICOS risk assessment for cancer therapy-related cardiovascular toxicity in adults with acute lymphoblastic leukemia

Data of cardiovascular health and its impact in acute lymphoblastic leukemia (ALL) is limited. We analyzed 164 patients with newly diagnosed ALL (median age 35 years) undergoing intensive chemotherapy to assess baseline cardiovascular risk and cardiac biomarkers impact on outcomes. Most common comorbidities were overweight/obesity (55.5%), smoking (27%), diabetes (15%), and hypertension (13%). Elevated hs-TnI and BNP were found in 8% and 32%, respectively. Using the HFA-ICOS tool, 70% of patients were classified with low-risk for cardiovascular toxicity, while the remaining comprised the moderate- and high-risk. Overall survival (OS) was better in the low-risk group (29 vs 10 months, <i>p</i> < 0.0001). Patients with moderate-high HFA-ICOS cardiac risk had higher induction-related mortality (HR 2.26, 95% CI 1.01-5.07; <i>p</i> = 0.048). Baseline biomarkers were associated with induction mortality and shorter OS. Baseline cardiovascular risk and cardiac biomarkers have prognostic impact on ALL patients. Preventive cardiovascular strategies may contribute to improved outcomes in this population.