ArticleEuropean journal of haematology2025
CLLAF SCORE-A New Risk Score for Predicting Atrial Fibrillation in Treatment-Naive CLL Patients Initiating First- and Second-Generation BTK Inhibitor Therapy.
Article in European journal of haematology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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- Bruton Tyrosine Kinase Inhibitors in Mantle Cell Lymphoma: What Are the Current Options?European journal of haematology · 2025Review
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Abstract
backgroundOne of the limiting toxicities of BTKi is the development of atrial fibrillation (AF), with an incidence of 3%-16%.
aimThis study aimed to identify patients with chronic lymphocytic leukemia (CLL) starting both first- and second-generation BTKis who are at high risk of developing AF using a machine learning approach.
methodsThe CLL cohort is based on data obtained from electronic medical records from Maccabi, the second-largest healthcare organization in Israel. The optimal scoring model was determined using the Risk-calibrated Supersparse Linear Integer Model (RiskSLIM) algorithm.
resultsA total of 3964 patients with a CLL diagnosis were available in the database. Of these, 208 patients started BTKi during the study period (125 on ibrutinib and 83 on acalabrutinib), and 16 patients developed AF during follow-up. In addition to well-established factors such as age, sex, and hypertension, the algorithm detected other factors associated with a high risk for AF: type of BTKi used, low eGFR, elevated absolute monocytes (> 1100/μL), elevated CRP, elevated CK, and elevated B2MG (> 2.5 mg/L). Based on the total AF-free survival (AFS), we identified three main risk groups: low (0-6), intermediate (7-11) and high (≥ 12). The median AF-free survival (AFS) was 28 and 56 months for the high-risk and intermediate-risk groups, respectively, and was not reached for the low-risk group. The difference between the groups was statistically significant (p = 0.0013).
conclusionOur novel score has a high concordance index for predicting the development of AF in patients with CLL treated with first- and second-generation BTKis. It combines age, sex, medical history, and laboratory tests associated with inflammatory status and disease burden and can be applied in clinical settings worldwide.
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