CD19‐targeting chimeric antigen receptor T‐cell therapy is safe and effective for intra‐cardiac B cell non‐Hodgkin lymphoma

Figures

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  FIGURE 1. A 24‐year‐old male with relapsed/refractory (r/r) large‐B‐cell‐lymphoma (LBCL) was treated with CD19‐targeting chimeric antigen receptor T‐cell (CD19CAR‐T). Computed tomography‐positron emission tomography (CT‐PET) demonstrated a 77 × 58 mm mass at the right hilum adjacent to the right atrium, with disease extension into the pericardium which was FDG‐avid. Small pericardial effusion (8 mm) on cardiac magnetic resonance imaging (CMR); no endomyocardial tumor invasion. CMR at day 28 post‐CD19CAR‐T Reduction in the right hilar mass on CMR at day 28 post‐CD19CAR‐T and Deauville 4 response on PET‐CT.

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  FIGURE 2. (A) A 46‐year‐old female with relapsed/refractory (r/r) large‐B‐cell‐lymphoma (LBCL) underwent treatment with CD19‐targeting chimeric antigen receptor T‐cell (CD19CAR‐T). FDG‐avid disease within the heart on computed tomography‐positron emission tomography (CT‐PET) at baseline, corresponding to multifocal myocardial and pericardial lymphomatous infiltration on cardiac magnetic resonance imaging (CMR) including an intramyocardial lateral left ventricle (LV) mass measuring 24 × 31 mm. CT‐PET at day 28 post‐CD19CAR‐T demonstrated a Deauville 4 response and regression of the intramyocardial LV wall mass without evidence of myocardial edema on CMR. (B) Fevers and grade 1 CRS were associated with an elevated NT‐proBNP; TnT levels did not change.

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  FIGURE 3. (A) A 50‐year‐old female with pericardial large‐B‐cell‐lymphoma (LBCL) was treated with CD19‐targeting chimeric antigen receptor T‐cell (CD19CAR‐T). Pericardial effusion on pre‐treatment cardiac magnetic resonance imaging (CMR) and a pericardial mass infiltrating the RV and RA with encasement of the right coronary artery, corresponding to FDG‐avid disease on computed tomography‐positron emission tomography (CT‐PET). CT‐PET assessment at day 28 demonstrated a Deauville 3 complete response and a significant reduction in the size of the pericardial mass on CMR. (B) Post CD19CAR‐T, she developed grade 2 CRS and LVSD associated with a rise in NT‐proBNP; TnT levels did not change.

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  FIGURE 4. (A) A 69‐year‐old female with relapsed/refractory (r/r) mantle cell lymphoma with pericardial involvement received CD19‐targeting chimeric antigen receptor T‐cell (CD19CAR‐T). Moderate, loculated pericardial effusion on pre‐treatment cardiac magnetic resonance imaging (CMR) consistent with metabolically active disease on computed tomography‐positron emission tomography (CT‐PET). Complete resolution of the pericardial effusion was seen on CT‐PET and CMR at month 3. (B) A paroxysm of AF during LD but prior to CD19CAR‐T resulted in pulmonary edema and NT‐proBNP elevation. Following CD19CAR‐T, she developed fevers and grade 1 CRS along with LVSD resulting in further NT‐proBNP elevation. TnT remained unchanged.

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  FIGURE 5. Management algorithm in patients receiving CD19‐targeting chimeric antigen receptor T‐cell (CD19CAR‐T) for B‐NHL with cardiac involvement—this includes careful pre‐treatment cardiac assessment with serum biomarkers, cardiac imaging, and electrocardiography (ECG), close surveillance during treatment and continuous monitoring within ICU, and early treatment of low‐grade CRS with tocilizumab and corticosteroids where appropriate.