Key result
CAR T-cell therapy is linked to ~50% cardiovascular toxicity, though clinically significant events are rare.
Why the study?
Real-world data on the incidence, severity, and prognostic relevance of cancer therapy-related cardiovascular toxicity defined by the 2022 ESC cardio-oncology guidelines remain limited in CAR T-cell therapy.
Cohort (n=104)
No
While half of patients receiving CAR T-cell therapy met ESC criteria for cardiovascular toxicity, clinically relevant events were rare, suggesting the guidelines may overclassify toxicity based on asymptomatic biomarker elevations.
High incidence of mostly asymptomatic cardiotoxicity in CAR T-cell therapy warrants vigilance; observational data leaves open optimal monitoring protocols.
Background Chimeric antigen receptor (CAR) T-cell therapy has substantially improved outcomes in refractory hematologic malignancies but may cause cardiovascular complications, particularly in the context of cytokine release syndrome (CRS). Real-world data on incidence, severity, and prognostic relevance of cancer therapy–related cardiovascular toxicity (CTR-CVT) defined by the 2022 ESC cardio-oncology guidelines remain in the context of CAR-T cell therapy limited. Methods This retrospective single-center study includes 104 patients treated with CAR T-cells between 09/2019 and 02/2024 for acute lymphoblastic leukemia, non-Hodgkin lymphoma and multiple myeloma. The primary endpoint was new-onset CTR-CVT during hospital stay, defined as cancer therapy–related cardiac dysfunction (CTRCD), arrhythmia, myocardial infarction, cardiogenic shock, or cardiovascular death. Clinical characteristics, biomarkers, echocardiographic parameters, CRS/ICANS severity, and survival outcomes were analyzed. Results Fifty-two patients (50%) met criteria for CTR-CVT, predominantly due to asymptomatic biomarker elevation. CTRCD occurred in 48.1%, whereas clinically significant events were rare: three patients developed symptomatic CTRCD, one experienced cardiogenic shock, and no myocardial infarctions or cardiovascular deaths were observed. Cardiovascular events occurred early and were associated with higher-grade CRS and ICANS, as well as elevated inflammatory markers. Reduced baseline left ventricular ejection fraction, elevated systolic pulmonary artery pressure, impaired performance status, and beta-blocker use were associated with increased CTR-CVT risk. Survival was numerically lower in patients with CTR-CVT but did not reach statistical significance. Conclusion Although half of patients fulfilled ESC criteria for CTR-CVT, clinically relevant cardiac events after CAR T-cell therapy were uncommon. These findings suggest potential overclassification driven by biomarker elevations and underscore the importance of emphasizing clinical relevance when assessing cardiotoxicity in CAR T-cell recipients.
No takes yet. Share an insight, caveat, or question.
Voran et al. (2026) conducted a cohort in Refractory hematologic malignancies (acute lymphoblastic leukemia, non-Hodgkin lymphoma, multiple myeloma) (n=104). CAR T-cell therapy was evaluated on New-onset cancer therapy-related cardiovascular toxicity (CTR-CVT) during hospital stay (95% CI 40.4-59.6). CAR T-cell therapy was associated with a 50% incidence of cancer treatment-related cardiovascular toxicity according to ESC criteria, though clinically significant cardiac events were rare.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: