ABSTRACT Aims Baseline cardiovascular (CV) risk stratification is an essential component in managing patients undergoing potential cardiotoxic anticancer therapies. Chimeric antigen receptor (CAR)‐T cell therapy, a groundbreaking treatment for hematologic malignancies, is associated with a non‐negligible risk of cardiovascular adverse events (CVAE). This study aimed to identify predictors of CAR‐T cell‐related CVAE and to develop a corresponding risk stratification score. Methods We conducted a meta‐analysis of studies comparing baseline clinical, biomarker, echocardiographic findings, and pharmaceutical treatments between patients who developed CAR‐T cell‐related CVAE and those who did not. We subsequently used the pooled relative risks (RR) of significant predictors to construct a risk stratification score. Results We identified 12 relevant studies encompassing a total of 1354 patients with haematologic malignancies, the majority of which were treated with CD19‐directed CAR‐T cell therapy, of whom 228 (16.8%) developed CVAE. Significant predictors of CAR‐T cell‐related CVAE included coronary artery disease RR = 2.27 (95% confidence interval, 1.46–3.51), hyperlipidaemia 1.57 (1.14–2.15), diabetes 1.59 (1.13–2.24), hypertension 1.45 (1.18–1.77), atrial fibrillation 2.42 (1.51–3.88), heart failure 2.74 (1.62–4.61), and smoking 1.40 (1.10–1.79). The resulting risk prediction score, incorporating the above seven factors, named CART‐7, ranges from 0 to 33, with a score of 0–8 indicating low risk, 9–17 moderate risk, 18–25 high risk, and 26–33 very high risk. Conclusion Seven baseline CV conditions were significantly associated with CAR‐T cell‐related CVAE. Further validation of the resulting CART‐7 score is warranted to support its clinical use in baseline CV risk stratification for patients undergoing CAR‐T cell therapy.
Farmakis et al. (2025) studied this question.