P189 | ROLE OF CARDIOVASCULAR RISK STRATIFICATION IN PATIENTS UNDERGOING AUTOLOGOUS STEM CELL TRANSPLANTATION FOR MULTIPLE MYELOMA: A REAL-LIFE SINGLE CENTRE EVALUATION.

Preventing cardiovascular complications in multiple myeloma (MM) patients (pts) receiving autologous stem cell transplant (ASCT) is crucial for improving outcomes and quality of life. The CASSIOPEIA trial showed a 6% incidence of cardiovascular events (CVE) in pts treated with Dara-VTd. Additionally, the increasing age of ASCT pts further contributes to the relevant cardiovascular risk (CVR). Recent European Cardiology and American Heart Association recommend the CARE-BMT Risk Score for assessing CVRs in pts to minimize CVE risk. We retrospectively analysed 57 consecutive MM pts who underwent ASCT with melphalan 200 mg/m² from January 2023 to January 2025 in our Institute. CV evaluations were performed at diagnosis, pre-ASCT and 1 year (y) post-ASCT and a cardiac prophylaxis strategy (or treatment of existing cardiac disease) was applied when appropriate. New CVE were tracked until 1 y post-ASCT. 57 pts were included (median age 62 y, range 43–71). Median follow-up was 2 y (range 103–3764 days). Pts’ characteristics are described in table 1, no pt had amyloidosis. All pts were treated with Dara-VTd induction, while 3 pts intensified the induction therapy with a carfilzomib-based scheme. All pts received cyclophosphamide 4 g/mq for stem cell mobilization and 7 pts needed a second mobilization to reach collection target. More than half of the pts had hypertension at the diagnosis of MM and 30 had a pre-existing cardiological therapy. In all pts, proBNP was monitored during therapy and ASCT without a substantial increase. According to the CARE-BMT Risk Score, 5 pts were classified as high risk, 46 intermediate risk and 6 low risk and pre-emptive therapy was introduced pre-ASCT in 1, 6 and 3 pts respectively. Among the intermediate risk group, 3/46 pts, all with age ≥ 65 y developed CE: 2 a new diagnosis of atrial fibrillation at 100 days post-ASCT and 1 a sustained ventricular tachycardia. No CVE were observed in the high and low risk group. One post-ASCT myocarditis was observed related to cytomegalovirus disease in the intermediate risk group. 28 patients underwent a second ASCT without an increase in CVE. No pt died for CVE. This single-centre data highlights the importance of multidisciplinary collaboration with cardiologists in preventing CVE in MM pts. CV evaluation at diagnosis and pre-ASCT, including the use of CARE-BMT Risk Score, helps identifying pts who require early intervention and appropriate management to mitigate adverse outcomes.