MDCalc

HFA-ICOS Baseline Cardio-Oncology Risk Assessment for Multi-Targeted Kinase Inhibitors for Chronic Myeloid Leukemia (CML)

Stratifies cardiotoxicity risk in CML cancer patients scheduled to receive BCR-ABL TKIs.

This tool is specifically for evaluating cardiotoxicity risk of BCR-ABL tyrosine kinase inhibitor (TKI) therapies.

Other HFA-ICOS cardiotoxicity risk assessments are available for the following therapies:

Previous Cardiovascular Disease

Arterial vascular disease (IHD, PCI, CABG, stable angina, TIA, stroke, PVD)

Arterial thrombosis with TKI

Heart failure or LVSD

BCR-ABL TKI-mediated LVSD 

Abnormal ABI (≤0.9)

Pulmonary arterial hypertension

See Evidence for more details.

Baseline LVEF <50%

Venous thromboembolism (DVT/PE

Arrhythmia

See Evidence for more details.

QTc

Demographic and Cardiovascular Risk Factors

Age, years

CVD 10 year risk score >20%

Hypertension

See Evidence for more details.

Diabetes mellitus

See Evidence for more details.

Hyperlipidemia

See Evidence for more details.

Chronic kidney disease

See Evidence for more details.

Family history of thrombophilia

Lifestyle Risk Factors

Current smoker or significant smoking history

Obesity (BMI >30 kg/m2)

Result:

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Advice

This tool is a decision-support aid and should be used alongside clinician judgment, patient preferences, specialist expertise, and current evidence-based guidelines/local protocols; results should not be the sole determinant of care.

Management
  • Low risk: Continue treatment with appropriate cardiovascular surveillance.
  • Medium risk: 
    • Provide closer monitoring of cardiovascular health. 
    • Manage cardiovascular risk factors.
    • Consider cardio-oncology or cardiology referral.
  • High and very high risk: 
    • Discuss risks and benefits of proposed chemotherapy.
    • Initiate closer cardiac monitoring.
    • Refer for cardio-oncology or cardiology assessment to optimise risk factors and provide a personalised management plan.
  • For more detailed guidance, please refer to the 2022 ESC guidelines.

Critical Actions

A referral to cardiology should be obtained for any patient who develops cardiotoxicity during therapy, regardless of initial risk.