T-cell Immunotherapy and Cardiovascular Disease: Chimeric Antigen Receptor T-cell and Bispecific T-cell Engager Therapies

Ashley F Stein-Merlob; Sarju Ganatra; Eric H Yang

doi:10.1016/j.hfc.2022.02.008

T-cell Immunotherapy and Cardiovascular Disease: Chimeric Antigen Receptor T-cell and Bispecific T-cell Engager Therapies

Heart Fail Clin. 2022 Jul;18(3):443-454. doi: 10.1016/j.hfc.2022.02.008.

Authors

Ashley F Stein-Merlob¹, Sarju Ganatra², Eric H Yang³

Affiliations

¹ Division of Cardiology, Department of Medicine, University of California at Los Angeles, Los Angeles, CA, USA; Division of Cardiology, Department of Medicine, UCLA-Cardio-Oncology Program, University of California at Los Angeles, Los Angeles, CA, USA. Electronic address: https://twitter.com/A_SteinMerlob.
² Cardio-Oncology Program, Division of Cardiovascular Medicine, Department of Medicine, Lahey Hospital and Medical Center, Burlington, MA, USA. Electronic address: sarju.ganatra@lahey.org.
³ Division of Cardiology, Department of Medicine, University of California at Los Angeles, Los Angeles, CA, USA; Division of Cardiology, Department of Medicine, UCLA-Cardio-Oncology Program, University of California at Los Angeles, Los Angeles, CA, USA. Electronic address: ehyang@mednet.ucla.edu.

PMID: 35718418
DOI: 10.1016/j.hfc.2022.02.008

Abstract

Chimeric antigen receptor (CAR) T-cell and bispecific T-cell engager (BiTE) therapies have revolutionized the treatment of refractory or relapsed leukemia and lymphoma. Increased use of these therapies has revealed signals of significant cardiotoxicity, including cardiomyopathy/heart failure, arrhythmia, myocardial injury, hemodynamic instability, and cardiovascular death mainly in the context of a profound inflammatory response to CAR T-cell antitumor effects known as cytokine release syndrome (CRS). Preexisting cardiovascular risk factors and disease may increase the risk of such cardiotoxicity. High index of suspicion and close monitoring is required for prompt recognition. Supportive hemodynamic care and targeted anti-IL-6 therapy, as well as possibly broader immunosuppression with corticosteroids, are the cornerstones of the management.

Keywords: Bispecific T-cell engager (BiTE) therapy; Cardio-Oncology; Cardiotoxicity; Chimeric Antigen Receptor (CAR) T-cell therapy; Immunotherapy.

Publication types

Review

MeSH terms

Cardiotoxicity
Cardiovascular Diseases* / therapy
Humans
Immunotherapy
Receptors, Chimeric Antigen* / therapeutic use
T-Lymphocytes

Substances

Receptors, Chimeric Antigen