Preliminary assessment of cardiotoxicity in chimeric antigen receptor T cell therapy: a systematic review and meta-analysis

Guo, Minjia; Wang, Xiaotong; Xiao, Shengjue; Liu, Aili; Xu, Tao; Huan, Chunyan; Wu, Huimin; Hu, Yue; Zhou, Shuaishuai; Zhu, Hong; Pan, Defeng

doi:10.1007/s10238-023-01042-z

Cited by 5 publications

(2 citation statements)

References 39 publications

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“…The incidence of cardiac events in patients receiving CAR-T cells varies between studies but is generally between 10 and 20% and occurs mainly in CRS grade ≥2 with elevated cardiac troponin and interleukin-6. 67 68 69 70 71 72 73 The most frequently observed CV events are profound hypotension requiring vasopressor support, arrhythmias including AF and ventricular tachycardias, as well as left ventricular dysfunction, decompensated HF, and CV death. 67 68 69 70 71 72 73…”

Section: Cardiotoxicity Of Targeted Therapies In Hematologymentioning

confidence: 99%

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Cardio-Oncology: A New Discipline in Medicine and Its Relevance to Hematology

Spannbauer,

Bergler-Klein

2024

Hamostaseologie

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Cardio-oncology, a burgeoning subspecialty, addresses the complex interplay between cardiology and oncology, particularly in light of increased cardiovascular (CV) disease mortality in cancer patients. This review provides a comprehensive overview of cardio-oncology with a focus on the therapies used in hematological malignancies. We explore the bidirectional relationship between heart failure and cancer, emphasizing the need for collaborative care. The review discusses risk stratification, highlighting the importance of baseline CV risk assessment and personalized surveillance regimens. Primary and secondary prevention strategies, including pharmacological interventions, are outlined. The review also delves into the cardiotoxicity associated with hematological cancer therapies, focusing on anthracyclines, Bruton kinase inhibitors, BCR-ABL tyrosine kinase inhibitors, CAR-T cell therapy, immune checkpoint inhibitors, multiple myeloma treatments, and hematopoietic stem cell transplantation. We then highlight the high risk of venous and arterial thromboembolisms in cancer patients and the challenges of anticoagulation management in cardio-oncology. Finally, the review touches on the importance of long-term follow-up and appropriate screening in cancer survivors at high risk of CV morbidity and mortality, based on their CV risk profile and the type and dose of cardiotoxic therapies they received such as anthracyclines or high radiation doses.

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Section: Cardiotoxicity Of Targeted Therapies In Hematologymentioning

confidence: 99%

“…67 68 69 70 71 72 73 The most frequently observed CV events are profound hypotension requiring vasopressor support, arrhythmias including AF and ventricular tachycardias, as well as left ventricular dysfunction, decompensated HF, and CV death. 67 68 69 70 71 72 73…”

Section: Cardiotoxicity Of Targeted Therapies In Hematologymentioning

confidence: 99%

Cardio-Oncology: A New Discipline in Medicine and Its Relevance to Hematology

Spannbauer,

Bergler-Klein

2024

Hamostaseologie

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Cardiovascular Events After Chimeric Antigen Receptor T-Cell Therapy for Advanced Hematologic Malignant Neoplasms

Koeckerling,

Reddy,

Barker

et al. 2024

JAMA Netw Open

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ImportanceThe frequency and clinical phenotypes of cardiotoxic events in chimeric antigen receptor (CAR) T-cell recipients remain poorly understood given that landmark approval trials typically exclude patients with high-risk cardiovascular profiles and data from nontrial settings are scarce.ObjectiveTo summarize the prevalence of adverse cardiovascular events among adults receiving CAR T-cell therapies for advanced hematologic malignant neoplasms.Data SourcesMEDLINE, Embase, Cochrane Library, and Google Scholar were systematically searched from database inception until February 26, 2024.Study SelectionObservational studies were included if they comprised adult CAR T-cell recipients with advanced hematologic malignant neoplasms and if they systematically evaluated cardiovascular complications.Data Extraction and SynthesisExtraction of prespecified parameters related to the patient population, study design, and clinical events was performed at the study level by 2 independent reviewers in accordance with the Meta-Analysis of Observational Studies in Epidemiology (MOOSE) reporting guideline. Meta-analysis of single proportions was conducted using random-effect models with Freeman-Tukey double arcsine transformations to calculate pooled prevalence estimates. Sensitivity analysis was performed using generalized linear mixed models with logit transformations.Main Outcomes and MeasuresVentricular and supraventricular arrhythmias, heart failure events, reduction in left ventricular ejection fraction, myocardial infarction, and cardiovascular and all-cause mortality.ResultsThirteen studies comprising 1528 CAR T-cell recipients (median [IQR] age, 61 [58.7-63.0] years; 1016 males [66%]; 80% patients with lymphoma) were included. The median (IQR) duration of follow-up was 487 (294-530) days. On random-effects meta-analysis, we observed a pooled prevalence of 0.66% (95% CI, 0.00%-2.28%) for ventricular arrhythmia, 7.79% (95% CI, 4.87%-11.27%) for supraventricular arrhythmia, 8.68% (95% CI, 2.26%-17.97%) for left ventricular dysfunction, 3.87% (95% CI, 1.77%-6.62%) for heart failure events, 0.62% (95% CI, 0.02%-1.74%) for myocardial infarction, and 0.63% (95% CI, 0.13%-1.38%) for cardiovascular death. The pooled prevalence of all-cause mortality was 30.01% (95% CI, 19.49%-41.68%). Sensitivity analyses generated similar findings.Conclusions and RelevanceThis meta-analysis found a low prevalence of ventricular arrhythmia, myocardial infarction, and cardiovascular death among CAR T-cell recipients over a short-term to midterm follow-up. Left ventricular dysfunction and supraventricular arrhythmia were the most commonly reported cardiovascular complications, suggesting that cardiovascular surveillance strategies should focus on decreases in ejection fraction and supraventricular arrhythmia.

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Engineered CAR-T cells: An immunotherapeutic approach for cancer treatment and beyond

Khodke,

Kumbhar

2024

Advances in Protein Chemistry and Structural Biology

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Preliminary assessment of cardiotoxicity in chimeric antigen receptor T cell therapy: a systematic review and meta-analysis

Cited by 5 publications

References 39 publications

Cardio-Oncology: A New Discipline in Medicine and Its Relevance to Hematology

Cardio-Oncology: A New Discipline in Medicine and Its Relevance to Hematology

Cardiovascular Events After Chimeric Antigen Receptor T-Cell Therapy for Advanced Hematologic Malignant Neoplasms

Engineered CAR-T cells: An immunotherapeutic approach for cancer treatment and beyond

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