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Open Access 21-01-2025 | Hypotension | REVIEW

Cardiotoxic Effects Following CAR-T Cell Therapy: A Literature Review

Authors: Tony Joseph, Jimmy Sanchez, Ahmed Abbasi, Lili Zhang, R. Alejandro Sica, Tim Q. Duong

Published in: Current Oncology Reports

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Abstract

Purpose of Review

This paper reviewed the current literature on incidence, clinical manifestations, and risk factors of Chimeric Antigen Receptor T-cell (CAR-T) cardiotoxicity.

Recent Findings

CAR-T therapy has emerged as a groundbreaking treatment for hematological malignancies since FDA approval in 2017. CAR-T therapy is however associated with a few side effects, among which cardiotoxicity is of significant concern. There were only a few studies on CAR-T cardiotoxicity published to date with limited sample sizes, and their findings were heterogeneous. It was difficult to reach generalizable conclusions.

Summary

CAR-T therapy was associated with significant risks for acute and subacute cardiotoxicity, as measured by echocardiograms, EKG, and blood biomarkers. Patients with cytokine release syndrome (CRS) grade 2 or higher were more likely to exhibit cardiotoxicity. The most prevalent cardiac events included hypotension-requiring inotropic or vasopressor support, tachycardia, heart failure/decompensation, atrial fibrillation, new or worsening cardiomyopathy, arrhythmia, myocarditis, cardiac arrest, and cardiovascular death. The most prevalent echocardiographic changes were systolic dysfunction and diastolic dysfunction, and abnormal echocardiogram findings. There were differences in findings between adult and pediatric patients. The long-term effects beyond a year post treatment remain largely unknown and long-term follow-up studies are warranted.
Appendix
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Literature
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go back to reference Brammer JE, Braunstein Z, Katapadi A, Porter K, Biersmith M, Guha A, Vasu S, Yildiz VO, Smith SA, Buck B, Haddad D. Early toxicity and clinical outcomes after chimeric antigen receptor T-cell (CAR-T) therapy for lymphoma. J ImmunoTher Cancer. 2021;9(8).https://doi.org/10.1136/jitc-2020-002303. Brammer JE, Braunstein Z, Katapadi A, Porter K, Biersmith M, Guha A, Vasu S, Yildiz VO, Smith SA, Buck B, Haddad D. Early toxicity and clinical outcomes after chimeric antigen receptor T-cell (CAR-T) therapy for lymphoma. J ImmunoTher Cancer. 2021;9(8).https://​doi.​org/​10.​1136/​jitc-2020-002303.
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go back to reference Shalabi H, Sachdev V, Kulshreshtha A, Cohen JW, Yates B, Rosing DR, Sidenko S, Delbrook C, Mackall C, Wiley B, et al. Impact of cytokine release syndrome on cardiac function following CD19 CAR-T cell therapy in children and young adults with hematological malignancies. J Immunother Cancer 2020, 8, https://doi.org/10.1136/jitc-2020-001159 Shalabi H, Sachdev V, Kulshreshtha A, Cohen JW, Yates B, Rosing DR, Sidenko S, Delbrook C, Mackall C, Wiley B, et al. Impact of cytokine release syndrome on cardiac function following CD19 CAR-T cell therapy in children and young adults with hematological malignancies. J Immunother Cancer 2020, 8, https://​doi.​org/​10.​1136/​jitc-2020-001159
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Metadata
Title
Cardiotoxic Effects Following CAR-T Cell Therapy: A Literature Review
Authors
Tony Joseph
Jimmy Sanchez
Ahmed Abbasi
Lili Zhang
R. Alejandro Sica
Tim Q. Duong
Publication date
21-01-2025
Publisher
Springer US
Published in
Current Oncology Reports
Print ISSN: 1523-3790
Electronic ISSN: 1534-6269
DOI
https://doi.org/10.1007/s11912-024-01634-2

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