Abstract 14394: Cardiovascular Toxicities After Chimeric Antigen Receptor T-cell (CAR-T) Therapy: A Single Center Experience

Abstract

Introduction: Chimeric Antigen Receptor (CAR)-T cell therapy has shown improved response rates in relapsed and refractory B-cell malignancies, but has been associated with adverse cardiac events. We investigated the correlation between pre-existing clinical factors and CAR-T cell therapy-related adverse cardiovascular (CV) events. Methods: Adult patients undergoing CAR-T cell therapy at Northwestern Memorial Hospital between 2016 and 2020 were identified. A comprehensive retrospective chart review was performed. CV events including CV death, new/worsening cardiomyopathy, and new/worsening arrhythmia were identified. Grade 2 cytokine release syndrome (CRS) with associated hypotension was a secondary outcome. Results: 75 patients (mean age 64 years) were identified. CV events occurred in ten patients (13%; mean age 71 years). One patient had CV death, 3 patients had new/worsening cardiomyopathy, and 6 patients had new/worsening arrhythmias. Eighteen patients with grade 2 CRS and hypotension were identified. Baseline characteristics differed between patients with vs. without post-therapy CV events (Table 1). Of the 11 patients with elevated post-infusion BNP, 6 experienced a CV event after CAR T-cell therapy (55%), whereas only 2 of the 16 patients without an elevated BNP had therapy-related cardiac events (13%; p-value = 0.03). Of 9 patients with pre-existing CAD, 3 experienced a CV event after CAR T-cell therapy (33%), whereas only 7 of the 66 patients without pre-existing CAD had CV events (11%; p-value=0.09). Conclusions: Patients with post-infusion elevation in BNP may have increased risk for CV adverse events following CAR-T cell therapy. Increased age and pre-existing CAD may also increase risk of CAR-T cell cardiotoxicity. Clinical factors predisposing to CAR-T cell therapy-related CV toxicity merit further investigation with larger sample sizes and prospective studies.