Cardiovascular complications and their association with short- and long-term outcomes in patients with multiple myeloma undergoing chimeric antigen receptor T-cell therapy.

Utilization of Investigations for Neurotoxicity in CD19 and BCMA CART Recipients

Chimeric Antigen Receptor T Cells: Toxicity and Management Considerations

Chimeric Antigen Receptor T-Cell Therapy Associated Cerebral Glucose Hypometabolism (CART-CGHM): A Novel Cerebral Metabolic Complication

Association of Bridging Therapy Utilization with Clinical Outcomes in Patients Receiving Chimeric Antigen Receptor (CAR) T-Cell Therapy

CAR T-cell therapy for solid tumours

Incidence of cytokine release syndrome (CRS), immune effector cell-associated neurotoxicity syndrome (ICANS), infections and cardiovascular events across different chimeric antigen receptor (CAR) T-cell therapy products in large B-cell lymphoma (DLBCL): A nationwide analysis

Demographic Characteristics, Incidence and Outcomes of Cytokine Release Syndrome and Immune Effector Cell-Associated Neurotoxicity Syndrome in Patients Undergoing CAR T-Cell Therapy: An Analysis of the National Inpatient Sample (NIS) - 2021

Real-time interleukin-6 (IL-6) kinetics predict cytokine release syndrome (CRS) in patients receiving chimeric antigen receptor (CAR) T-cell therapy for Relapsed/Refractory B-cell malignancies

Real-world comparison of CAR T-cell therapy versus bispecific antibodies in relapsed or refractory multiple myeloma

e24025 Background: With the expansion of Chimeric Antigen Receptor T-Cell (CAR-T) Therapy in hematologic malignancies, significant treatment adverse effects have been observed. The exploration of cardiovascular effects has been limited due to a paucity in the number of patients in previous studies. This study analyzes CAR-T Therapy related cardiovascular toxicities with a nation-wide dataset, the National Inpatient Sample (NIS) of the United States. Methods: NIS 2022 data were used to analyze the frequency of cardiovascular adverse events in patients aged 18 years and older. In subgroup analysis, relapsed acute lymphoblastic leukemia (ALL) and multiple myeloma (MM) patients were included in the analysis using the International Classification of Diseases (ICD)-10 code. The primary outcomes are the frequency of cardiovascular adverse effects, including arrhythmia, stroke, heart failure (HF), and cardiac arrest. Results: A total of 763 patients received CAR-T Therapy in NIS 2022. MM showed the highest incidence among disease types (24.25%). The distribution was as followed: Diffuse large B-Cell lymphoma (DLBCL) (9.17%), ALL (7.47%), follicular B cell lymphoma (2.36%), acute myeloblastic leukemia (AML) (1.83%), and mantle cell lymphoma (0.92%). In the relapsed ALL subgroup, the rate of atrial fibrillation and atrial flutter was significantly higher in the patients who received CAR-T Therapy compared to those who did not (15% vs 6.43%, p = 0.048). However, MM patients with CAR-T Therapy did not show significant difference in atrial fibrillation and atrial flutter (14.81% vs 19.38%, p = 0.313). The rates of HF, stroke, and cardiac arrest were not significant in the ALL and MM subgroups. Patients with cytokine release syndrome grade 3 or higher were associated with grater incidences of HF and stroke (HF; 16% vs 5.28%, p = 0.047, stroke; 0.81% vs 8%, p = 0.026). Conclusions: To our understanding, this is the first nation-wide study regarding cardiotoxicity in CAR-T Therapy, representing the general patient population in the United States. Relapsed ALL patients who received CAR-T Therapy showed higher rates of arrhythmias, including atrial fibrillation and atrial flutter than those who did not. Further studies in a larger population are warranted. In addition, cardiovascular adverse effects in CAR-T Therapy patients with B cell lymphoma should be further explored. This study underscores the critical need for vigilant cardiovascular monitoring and management in CAR-T Therapy recipients. Further research should elucidate the underlying mechanism of CAR-T Therapy related cardiotoxicity, developing strategies to mitigate the adverse effects.

Background Chimeric antigen receptor (CAR) T-cell immunotherapy is increasingly used for refractory lymphoma but may lead to cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS). Imaging may assist in clinical management. Associations between CRS or ICANS grade and imaging findings remain not fully established. Purpose To determine associations between imaging findings and clinical grade of CRS or ICANS, evaluate response patterns, and assess imaging use following CAR T-cell treatment. Materials and Methods Patients with refractory B-cell lymphoma who received CAR T-cell infusion between 2018 and 2020 at a single center were analyzed retrospectively. Clinical CRS or ICANS toxicity grade was assessed using American Society for Transplantation and Cellular Therapy, or ASTCT, consensus grading. Thoracic and head images (radiographs, CT scans, MRI scans) were evaluated. Associations between imaging findings and clinical CRS or ICANS grade were analyzed. Wilcoxon signed-rank and χ2 tests were used to assess associations between thoracic imaging findings, clinical CRS toxicity grade, and imaging-based response. Response to therapy was evaluated according to Deauville five-point scale criteria. Results A total of 38 patients (mean age ± standard deviation, 59 years ± 10; 23 men) who received CAR T-cell infusion were included. Of these, 24 (63% [95% CI: 48, 79]) and 11 (29% [95% CI: 14, 44]) experienced clinical grade 1 or higher CRS and ICANS, respectively. Patients with grade 2 or higher CRS were more likely to have thoracic images with abnormal findings (10 of 14 patients [71%; 95% CI: 47, 96] vs five of 24 patients [21%; 95% CI: 4, 37]; P = .002) and more likely to have imaging evidence of pleural effusions (five of 14 [36%; 95% CI: 10, 62] vs two of 24 [8.3%; 95% CI: 0, 20]; P = .04) and atelectasis (eight of 14 [57%; 95% CI: 30, 84] vs six of 24 [25%; 95% CI: 7, 43]; P = .048). Positive imaging findings were identified in three of seven patients (43%) with grade 2 or higher ICANS who underwent neuroimaging. The best treatment response included 20 of 36 patients (56% [95% CI: 39, 72]) with complete response, seven of 36 (19% [95% CI: 6, 33]) with partial response, one of 36 (2.8% [95% CI: 0, 8]) with stable disease, and eight of 36 (22% [95% CI: 8, 36]) with progressive disease. Conclusion Thoracic imaging findings, including pleural effusions and atelectasis, correlated with cytokine release syndrome grade following chimeric antigen receptor (CAR) T-cell infusion. CAR T-cell therapy yielded high response rates. © RSNA, 2021 Online supplemental material is available for this article. See also the editorial by Langer in this issue.

High-dose anakinra to treat refractory immune effector cell-associated neurotoxicity syndrome in CAR T-cell therapy recipients

Glofitamab based combined therapy as bridging therapy before stem cell transplants and CAR-T therapy in large B-cell lymphoma.

Advancing CAR T-Cell Care in Relapsed/Refractory Multiple Myeloma: Insights from a Collaborative Quality Improvement Initiative

Autoimmune Outcomes in Patients with Concurrent Autoimmune Disease Receiving CD19 CAR T-Cell Therapy for Lymphoma