Chimeric Antigen Receptor T-Cell Therapy for Cancer and Heart: JACC Council Perspectives

Sarju Ganatra, Joseph R. Carver, Salim S. Hayek, Bonnie Ky, Monika J. Leja, Daniel J. Lenihan, Carrie Lenneman, Negaresh Mousavi, Jae H. Park, Miguel Angel Perales, Thomas D. Ryan, Marielle Scherrer-Crosbie, Richard M. Steingart, Eric H. Yang, Vlad Zaha, Ana Barac, Jennifer E. Liu

Research output: Contribution to journalReview article

3 Scopus citations

Abstract

Chimeric antigen receptor (CAR) T-cell therapy has significantly advanced the treatment of patients with relapsed and refractory hematologic malignancies and is increasingly investigated as a therapeutic option of other malignancies. The main adverse effect of CAR T-cell therapy is potentially life-threatening cytokine release syndrome (CRS). Clinical cardiovascular (CV) manifestations of CRS include tachycardia, hypotension, troponin elevation, reduced left ventricular ejection fraction, pulmonary edema, and cardiogenic shock. Although insults related to CRS toxicity might be transient and reversible in most instances in patients with adequate CV reserve, they can be particularly challenging in higher-risk, often elderly patients with pre-existing CV disease. As the use of CAR T-cell therapy expands to include a wider patient population, careful patient selection, pre-treatment cardiac evaluation, and CV risk stratification should be considered within the CAR T-cell treatment protocol. Early diagnosis and management of CV complications in patients with CRS require awareness and multidisciplinary collaboration.

Original languageEnglish (US)
Pages (from-to)3153-3163
Number of pages11
JournalJournal of the American College of Cardiology
Volume74
Issue number25
DOIs
StatePublished - Dec 24 2019

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Keywords

  • cardiotoxicity
  • chimeric antigen receptor T-cell therapy
  • cytokine release syndrome

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Ganatra, S., Carver, J. R., Hayek, S. S., Ky, B., Leja, M. J., Lenihan, D. J., Lenneman, C., Mousavi, N., Park, J. H., Perales, M. A., Ryan, T. D., Scherrer-Crosbie, M., Steingart, R. M., Yang, E. H., Zaha, V., Barac, A., & Liu, J. E. (2019). Chimeric Antigen Receptor T-Cell Therapy for Cancer and Heart: JACC Council Perspectives. Journal of the American College of Cardiology, 74(25), 3153-3163. https://doi.org/10.1016/j.jacc.2019.10.049