Key result
CD-19 directed CAR-T cell infusion triggers severe acute coronary vasospasm and ST-segment elevations.
Why the study?
Cardiovascular events occur in one in five patients receiving CAR-T therapy, but acute ST segment elevation during infusion had not been described.
Case Report (n=1)
No
CAR-T cell therapy infusion can trigger acute coronary vasospasm and ST elevation myocardial infarction, highlighting the need for vigilance and characterization of its full cardiotoxic spectrum.
Answers are grounded in this paper and cite their sources.
Requires vigilance for vasospasm early in CAR-T infusion; leaves open the full cardiotoxicity spectrum for prospective characterization.
Background: Cardiovascular events have been reported to occur in one in five patients receiving chimeric antigen receptor T-cell (CAR-T) therapy. Commonly reported effects including cardiomyopathy, heart failure, myocardial infarction (MI), and arrhythmia. Here, we present a novel case of a patient who developed acute ST segment elevations during CAR-T cell infusion. Case summary: A 76-year-old man with diffuse large B cell lymphoma was admitted for an investigational CD-19 directed, autologous CAR-T cell therapy. Less than 5 min into the CAR-T cell infusion, he developed severe chest pain, dyspnea, flushing, hypotension, and tachycardia. Electrocardiogram (EKG) showed inferior ST elevations and reciprocal lateral ST depressions. Emergent coronary angiography revealed mild non-obstructive coronary disease. ST segment changes and patient symptoms resolved after catheterization. Discussion: Given the complete resolution of symptoms and EKG abnormalities in the context of non-obstructive coronary artery disease, this clinical presentation was thought to be most consistent with ST elevation MI due to coronary vasospasm. The mechanism of this vasospasm is as yet not understood and may be related to an anaphylactic reaction or a cardiotoxicity related to the cell therapy agent. As the use of CAR-T therapy continues to expand, there is a need to further characterize the full spectrum of its cardiotoxic effects.
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Tao et al. (2023) conducted a case report in Stage IV intraorbital diffuse large B cell lymphoma (n=1). Investigational CD-19 directed, autologous CAR-T cell therapy was evaluated on Acute coronary vasospasm. A 76-year-old man developed severe chest pain and ST segment elevations due to coronary vasospasm less than 5 minutes into an infusion of CD-19 directed CAR-T cell therapy.
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