CAR T Cell Therapy May Increase Risk Of Serious Heart Problems: Study

Patients who underwent a specialized stem cell therapy for cancer may face an increased risk of serious heart problems, according to the findings of a new study.

Researchers from the University of Pennsylvania report that more than 20% of patients who received anti-CD19 chimeric antigen receptor (CAR) T-cell therapy developed major cardiovascular side effects. The findings were published online last week in the medical journal JACC: CardioOncology.

The study focused on the cardiac side effects of CAR T-cell therapy used to treat patients with hematologic malignancies, including data on 145 adult patients undergoing the treatment. Of those, 36 patients had acute lymphocytic leukemia, 43 patients had diffuse large B-cell lymphoma, and 66 patients had chronic lymphocytic leukemia.

The researchers looked at the occurrence of major adverse cardiovascular events (MACE) among the patients. MACE events include cardiovascular death, symptomatic heart failure, acute coronary syndrome, ischemic stroke, and de novo cardiac arrhythmia.

Overall, 31 patients suffered a combined total of 41 MACE events. These events included 22 episodes of heart failure, 12 episodes of atrial fibrillation, two cases of acute coronary syndrome, two cardiac deaths, one episode of supra ventricular tachycardia, and one episode of non-sustained ventricular tachycardia.

The average time a patient suffered heart problems after having CAR T-cell infusion was 11 days.

A total of 61 patients died. All but two deaths were due to cardiac causes.

Cytokine release syndrome occurred 176 times in 104 patients. The average time to cytokine release syndrome occurrence after infusion was six days. Cytokine release syndrome is a recognized and potentially serious complication of CAR T-cell therapy.

Roughly 17% of patients had a MACE event within 30 days of T-cell infusion. Another 19% of patients had an event within 6 months and 21% at 12 months after infusion.

Patients who had major heart problems tended to be younger men with higher rates of cardiac risk factors at the time of treatment.

Adults who underwent the CAR T-cell therapy had refractory and relapsed lymphomas that were often treated with multiple rounds of anthracycline-based chemotherapy and chest radiation. Both treatments are established as having cardiotoxic effects and can lead to serious adverse heart events.

Other studies have shown cardiac complications in pediatric patients who were treated with CAR T-cell therapy. One study indicated more than one-third of patients developed cardiogenic shock.

“Patients treated with CAR T-cell therapy are at an increased risk for MACE and may benefit from cardiovascular surveillance,” the researchers concluded. “Given that CAR T cell use will only increase in the future and that no recommendations for monitoring and follow-up of left ventricular function and MACE currently exist, prospective studies are needed to ascertain the incidence and predictors of MACE.”