CAR T Cell and BiTE Therapy—New Therapies, New Risks?

Abstract

T cell engaging immunotherapies, including chimeric antigen receptor (CAR) T cells and bispecific T cell engager (BiTE) antibodies have had recent and unprecedented success in the management of relapsing and refractory haematological malignancies. However, the potency of these novel immunotherapies is associated with significant toxicities. This review seeks to highlight the current understanding of cardiovascular toxicity-associated T cell engaging immunotherapies. The most common and best described toxicity due to T cell engaging immunotherapies is cytokine release syndrome (CRS). However, whilst cardiovascular toxicity is also associated, its full extent and characteristics remain incompletely described. A broad spectrum of cardiovascular complications have already been observed and reported in retrospective cohorts and can include sinus tachycardia, atrial and ventricular arrhythmias, elevations in serum troponins, left ventricular systolic dysfunction, decompensated cardiac failure, profound hypotension requiring vasopressor and intensive care unit support, and cardiovascular death. Future research through prospective studies need to encompass advanced cardiac imaging modalities, as well as novel and current serum biomarkers, to truly characterise the cardiac safety profile of T cell engaging immunotherapies. This will subsequently drive the development of evidence-based cardiac surveillance and primary and secondary prevention strategies to allow the full potential of T cell engaging immunotherapies to be realised.