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J Am Coll Cardiol. 2019 Dec 24;74(25):3153-3163. doi: 10.1016/j.jacc.2019.10.049.

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

Author information

1
Cardio-Oncology Program, Division of Cardiovascular Medicine, Department of Medicine, Lahey Hospital and Medical Center, Burlington, Massachusetts; Cardio-Oncology and Adult Cancer Survivorship Program, Dana Farber Cancer Institute, Boston, Massachusetts; Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
2
Cardio-Oncology Program, Division of Cardiovascular Medicine, Department of Medicine, Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania.
3
Division of Cardiology, University of Michigan, Ann Arbor, Michigan.
4
Cardio-Oncology Center of Excellence, Division of Cardiovascular Medicine, Department of Medicine, Washington University, St. Louis, Missouri.
5
Division of Cardiovascular Medicine, Department of Medicine, University of Alabama, Birmingham, Alabama.
6
Cardio-Oncology Program, Division of Cardiovascular Medicine, Department of Medicine, McGill University Health Center, Montreal, Quebec, Canada.
7
Leukemia Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York.
8
Department of Medicine, Weill Cornell Medical College, New York, New York; Adult Bone Marrow Transplant, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.
9
Heart Institute, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, Cincinnati College of Medicine, Cincinnati, Ohio.
10
Cardio-Oncology Program and Cardiac Ultrasound Laboratory, Division of Cardiology, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
11
Department of Medicine, Weill Cornell Medical College, New York, New York; Cardiology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.
12
Cardio-Oncology Program, Division of Cardiovascular Medicine, Department of Medicine, Ronald Reagan University of California Los Angeles Medical Center, Los Angeles, California.
13
Cardio-Oncology Program, Division of Cardiovascular Medicine, Department of Medicine, University of Texas Southwestern Medical Center, Divison of Cardiovascular Medicine, Department of Medicine, Dallas, Texas.
14
Cardio-Oncology Program, Department of Cardiology, MedStar Washington Hospital Center, MedStar Heart and Vascular Institute, Washington, DC. Electronic address: Ana.Barac@medstar.net.
15
Department of Medicine, Weill Cornell Medical College, New York, New York; Cardiology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York. Electronic address: liuj1234@mskcc.org.

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.

KEYWORDS:

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

PMID:
31856973
DOI:
10.1016/j.jacc.2019.10.049
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