Key result
Cytokine release syndrome after CAR-T therapy shows no statistically significant increase in MACE risk.
Why the study?
Severe cytokine release syndrome during CAR-T therapy carries high cardiovascular risk, and early tocilizumab may lower MACE rates.
Does early use of tocilizumab for cytokine release syndrome reduce major adverse cardiovascular events without compromising progression-free survival in patients undergoing CAR-T therapy for multiple myeloma?
Cohort (n=145)
No
Does early use of tocilizumab for cytokine release syndrome reduce major adverse cardiovascular events without compromising progression-free survival in patients undergoing CAR-T therapy for multiple myeloma?
Absolute Event Rate: 11.7% vs 0%
p-value: p=0.0794
In patients with multiple myeloma undergoing CAR-T therapy, early use of tocilizumab for cytokine release syndrome is associated with a relatively low incidence of major adverse cardiovascular events without compromising progression-free survival.
Early tocilizumab for CRS was associated with modest MACE rates; leaves open whether it mitigates cardiovascular risk in CAR-T recipients without affecting PFS.
Chimeric antigen receptor-T cell (CAR-T) therapies are approved for refractory and relapsed multiple myeloma (MM). Patients with MM have high cardiovascular disease burden due to age and cardiotoxic treatments. Retrospective studies in patients who develop severe grades of cytokine release syndrome (CRS) demonstrated a 20-30% major cardiovascular adverse event (MACE) rate. Early use of the interleukin-6 receptor antagonist, tocilizumab, to reverse CRS may lower rates of MACE. This observational study sought to examine the relationship between early use of tocilizumab and the development of MACE. Single-center retrospective chart review of adults undergoing CAR-T therapy for MM between 2017 and 2023. MACE was defined as composite of myocardial injury, heart failure, stroke, arrhythmias and cardiovascular death over a median period of 12 months. The secondary outcomes were progression free survival (PFS) and overall survival (OS). MACE incidence was estimated using the cumulative incidence function with non-cardiovascular death as a competing risk and compared by Gray’s test, and PFS/OS were analyzed using Kaplan–Meier methods with log-rank tests. Of the 145 patients studied, CRS occurred in 120 patients (82%). Of those with CRS, 107 (89%) received tocilizumab within 24 hours. Within 1 year of therapy, 14 patients (9.7%) experienced MACE. Only patients with CRS developed MACE. The incidence of MACE was 8% [95% CI: 5%, 14%] at 6 months and 11% [95% CI: 7%, 19%] at 12 months. Progression free survival at 12 months was 58% [95% CI: 50%, 68%]. PFS and OS did not differ significantly based on incidence on CRS.
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Golec et al. (2026) conducted a cohort in Refractory and relapsed multiple myeloma undergoing CAR-T therapy (n=145). Cytokine release syndrome (majority treated with early tocilizumab) vs. No cytokine release syndrome was evaluated on Composite of myocardial injury, cerebrovascular accident, tachyarrhythmia, heart failure, or cardiovascular death (p=0.0794). In patients with multiple myeloma treated with CAR-T therapy, those developing cytokine release syndrome (mostly treated with early tocilizumab) had a MACE rate of 11.7%, compared to 0% in those without CRS (p=0.0794).
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