CAR T-cell therapy had low acute cardiac events (2% Germany, 1.5% US), but patients with preexisting cardiac conditions had 89% higher long-term cardiovascular risk.
Do preexisting cardiac conditions increase the risk of cardiovascular and immune-related complications in patients undergoing CAR T-cell therapy?
Severe cardiac events following CAR T-cell therapy are rare overall, but patients with preexisting cardiac conditions have a significantly higher long-term risk of major cardiovascular events, highlighting the need for targeted cardiological follow-up.
Abstract Background CAR T-cell therapy is becoming a key pillar of medical oncology, used for an expanding range of indications. Its age-independent efficacy makes it a common option for older patients. Considering the increased risk of cardiovascular disease with increasing age, assessing the impact of cardiac comorbidities can help minimizing complications through and enhance treatment outcomes. Objectives This retrospective study evaluates cardiovascular outcomes in patients undergoing CD19- or BCMA-directed CAR T-cell therapy from two large independent databases. Methods Using ICD and procedural codes, the population-based DESTATIS-database (Germany) and the TriNetX Health network (US) were queried for cardiovascular outcomes after CAR T-cell therapy. Results Among 2,545 CAR T-cell cases from Germany and 1,335 patients from the US, we identified short-term severe cardiac events in 51 (2%) and 20 (1.5%) cases with early death documented in 135 (5%) and 16 (1.2%) patients. Patients with preexisting cardiac conditions did not show an increased risk for immune-related complications like cytokine release (OR 1.19, 95%CI 0.77-1.82) or neurotoxicity syndrome (OR 1.59, 95%CI 0.94-2.69). However, they faced higher long-term risks for major cardiovascular events (OR 1.89, 95%CI 1.23-2.91) and kidney failure (OR 2.98, 95%CI 1.85-4.81). Conclusion Cardiovascular complications in CAR T-cell therapy were rare and primarily affected patients with preexisting cardiac conditions. Serious cardiac events were uncommon acutely but increased over time, particularly in cardiology patients. Due to its retrospective nature, the analysis cannot guide patient selection but underscores the need for risk-adapted follow-up and regular cardiological assessments to improve outcomes in patients with cardiac comorbidities.
Voran et al. (2025) studied this question. CAR T-cell therapy had low acute cardiac events (2% Germany, 1.5% US), but patients with preexisting cardiac conditions had 89% higher long-term cardiovascular risk.