CAR T Cell Therapy–Related Cardiovascular Outcomes and Management: Systemic Disease or Direct Cardiotoxicity? (JACC: CardioOncology March 2020)
CD19-specific chimeric antigen receptor (CAR) T cell therapies have shown remarkable early success in highly refractory and relapsing hematological malignancies. However, this potent therapy is accompanied by significant toxicity. Cytokine release syndrome and neurotoxicity are the most widely reported, but the true extent and characteristics of cardiovascular toxicity remain poorly understood. Thus far, adverse cardiovascular effects observed include sinus tachycardia and other arrhythmias, left ventricular systolic dysfunction, profound hypotension, and shock requiring inotropic support. The literature regarding cardiovascular toxicities remains sparse; prospective studies are needed to define the cardiac safety of CAR T cell therapies to optimally harness their potential. This review summarizes the current understanding of the potential cardiovascular toxicities of CD19-specific CAR T cell therapies, outlines a proposed cardiac surveillance protocol for patients receiving this new treatment, and provides a roadmap of the future direction of cardio-oncology research in this area.
Editor
JACC Editor-in-Chief and CME Editor
Bonnie Ky, MD, MSCE, FACC
Authors
Arjun K. Ghosh, MBBS, MSC, PHD
Daniel H. Chen, BMED
Avirup Guha, MD
Strachan Mackenzie, MBBS, BSC
J. Malcolm Walker, MD
Claire Roddie, MD, PHD
CME Information
Target Audience
JACC Journal CME/MOC/ECME is intended for physicians who treat patients with cardiovascular disease.
Important Dates
Date of Release: March 17, 2020
Term of Approval/Date of CME/MOC/ECME Expiration: March 16, 2021
Learner Objectives
After reading this article the reader should be able to:
- Identify the mechanism of action of cluster of differentiation 19–specific chimeric antigen receptor (CAR) T-cell therapy in relapsed and refractory B-cell hematological malignancies.
- Discuss the common adverse effects associated with CAR T-cell therapy and the patients most at risk of developing these adverse effects.
- Discuss the treatment options for common adverse effects associated with CAR T-cell therapy.
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