Role of Cardio-Oncology Rehabilitation in Hematopoietic Stem Cell Transplantation and Chimeric Antigen Receptor T-Cell (CAR-T) Therapy

Figures

• 

  Figure 1.. Cardiovascular adverse events associated with HSCT. During HSCT, in addition to direct cardiovascular adverse events caused by conditioning regimens, severe infections due to neutropenia pose a risk of septic cardiomyopathy. GVHD can lead to myocarditis, pericarditis, and pulmonary hypertension, and the immunosuppressive therapies used for GVHD prevention may also contribute to myocardial injury. GVHD, graft-vs.-host disease; HSCT, hematopoietic stem cell transplantation.

• 

  Figure 2.. Indications for CORE during HSCT and CAR-T therapies. Patients with cardiovascular symptoms or a history of cardiovascular disease are advised to undergo a cardio-oncology consultation, including cardiovascular assessments with CPX, followed by the implementation of CORE. Additionally, all high-risk patients are recommended to undergo cardiovascular evaluations before HSCT or CAR-T therapy, regardless of symptoms. CAR-T, chimeric antigen receptor T-cell; CORE, Cardio-Oncology Rehabilitation; CPX, cardiopulmonary exercise testing; HSCT, hematopoietic stem cell transplantation.

• 

  Figure 3.. Cardiopulmonary function evaluation and exercise prescription during HSCT and CAR-T therapies. Before conditioning or lymphodepletion for HSCT or CAR-T therapy, cardiac function is evaluated, including ECG, transthoracic echocardiography, and blood tests (troponin, BNP/NTproBNP, cholesterol, HbA1c, etc.). CPX is conducted to assess exercise tolerance and develop a rehabilitation protocol. One week after infusion, ECG and cardiac biomarkers are reassessed, with additional evaluations conducted as needed. Before discharge, cardiac function and CPX are reassessed at 6 weeks post-transplant for HSCT or 3 weeks post-CAR-T therapy. CAR-T, chimeric antigen receptor T-cell; CPX, cardiopulmonary exercise testing; HSCT, hematopoietic stem cell transplantation.