TY - JOUR
T1 - Chimeric Antigen Receptor T-Cell Therapy for Cancer and Heart
T2 - JACC Council Perspectives
AU - Ganatra, Sarju
AU - Carver, Joseph R.
AU - Hayek, Salim S.
AU - Ky, Bonnie
AU - Leja, Monika J.
AU - Lenihan, Daniel J.
AU - Lenneman, Carrie
AU - Mousavi, Negaresh
AU - Park, Jae H.
AU - Perales, Miguel Angel
AU - Ryan, Thomas D.
AU - Scherrer-Crosbie, Marielle
AU - Steingart, Richard M.
AU - Yang, Eric H.
AU - Zaha, Vlad
AU - Barac, Ana
AU - Liu, Jennifer E.
N1 - Funding Information:
The authors thank Dr. Nikola Kolundzic for preparing Figure 1. Dr. Ky has received consulting fees from Bristol-Myers Squibb. Dr. Lenihan has received research funding from Myocardial Solutions; and has received consultant fees from Roche, BMS, Pfizer, Prothena, Lilly, and Acorda. Dr. Park has received honoraria for consulting or Advisory Board services from Kite Pharma, Novartis, Amgen, Allogene, Autolus, GlaxoSmithKline, AstraZeneca, and Takeda. Mr. Perales has received research support for clinical trials from Incyte, Kite Pharma/Gilead Sciences, and Milenyi Biotec; has received honoraria from Abbvie, Bellicum, Bristol-Myers Squibb, Incyte, Merck, Novartis, Nektar Therapeutics, and Takeda; has served on Data and Safety Monitoring Boards for Servier and Medigene; and has served on Scientific Advisory Boards of MolMed and NexImmune. Dr. Steingart has been a consultant to a Data and Safety Monitoring Board for Pfizer. Dr. Zaha has received research support from the Cancer Prevention Research Institute of Texas. Dr. Barac has received honoraria and consulting fees from Bristol-Myers Squibb; and has served on the Data and Safety Monitoring Board for CTI BioPharma. Dr. Liu has received consultant fees from Bay Labs for work unrelated to the topic of the paper. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
Funding Information:
Dr. Ky has received consulting fees from Bristol-Myers Squibb. Dr. Lenihan has received research funding from Myocardial Solutions; and has received consultant fees from Roche, BMS, Pfizer, Prothena, Lilly, and Acorda. Dr. Park has received honoraria for consulting or Advisory Board services from Kite Pharma, Novartis, Amgen, Allogene, Autolus, GlaxoSmithKline, AstraZeneca, and Takeda. Mr. Perales has received research support for clinical trials from Incyte, Kite Pharma/Gilead Sciences, and Milenyi Biotec; has received honoraria from Abbvie, Bellicum, Bristol-Myers Squibb, Incyte, Merck, Novartis, Nektar Therapeutics, and Takeda; has served on Data and Safety Monitoring Boards for Servier and Medigene; and has served on Scientific Advisory Boards of MolMed and NexImmune. Dr. Steingart has been a consultant to a Data and Safety Monitoring Board for Pfizer. Dr. Zaha has received research support from the Cancer Prevention Research Institute of Texas. Dr. Barac has received honoraria and consulting fees from Bristol-Myers Squibb; and has served on the Data and Safety Monitoring Board for CTI BioPharma. Dr. Liu has received consultant fees from Bay Labs for work unrelated to the topic of the paper. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
Publisher Copyright:
© 2019 American College of Cardiology Foundation
PY - 2019/12/24
Y1 - 2019/12/24
N2 - Chimeric antigen receptor (CAR) T-cell therapy has significantly advanced the treatment of patients with relapsed and refractory hematologic malignancies and is increasingly investigated as a therapeutic option of other malignancies. The main adverse effect of CAR T-cell therapy is potentially life-threatening cytokine release syndrome (CRS). Clinical cardiovascular (CV) manifestations of CRS include tachycardia, hypotension, troponin elevation, reduced left ventricular ejection fraction, pulmonary edema, and cardiogenic shock. Although insults related to CRS toxicity might be transient and reversible in most instances in patients with adequate CV reserve, they can be particularly challenging in higher-risk, often elderly patients with pre-existing CV disease. As the use of CAR T-cell therapy expands to include a wider patient population, careful patient selection, pre-treatment cardiac evaluation, and CV risk stratification should be considered within the CAR T-cell treatment protocol. Early diagnosis and management of CV complications in patients with CRS require awareness and multidisciplinary collaboration.
AB - Chimeric antigen receptor (CAR) T-cell therapy has significantly advanced the treatment of patients with relapsed and refractory hematologic malignancies and is increasingly investigated as a therapeutic option of other malignancies. The main adverse effect of CAR T-cell therapy is potentially life-threatening cytokine release syndrome (CRS). Clinical cardiovascular (CV) manifestations of CRS include tachycardia, hypotension, troponin elevation, reduced left ventricular ejection fraction, pulmonary edema, and cardiogenic shock. Although insults related to CRS toxicity might be transient and reversible in most instances in patients with adequate CV reserve, they can be particularly challenging in higher-risk, often elderly patients with pre-existing CV disease. As the use of CAR T-cell therapy expands to include a wider patient population, careful patient selection, pre-treatment cardiac evaluation, and CV risk stratification should be considered within the CAR T-cell treatment protocol. Early diagnosis and management of CV complications in patients with CRS require awareness and multidisciplinary collaboration.
KW - cardiotoxicity
KW - chimeric antigen receptor T-cell therapy
KW - cytokine release syndrome
UR - http://www.scopus.com/inward/record.url?scp=85076042932&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85076042932&partnerID=8YFLogxK
U2 - 10.1016/j.jacc.2019.10.049
DO - 10.1016/j.jacc.2019.10.049
M3 - Review article
C2 - 31856973
AN - SCOPUS:85076042932
SN - 0735-1097
VL - 74
SP - 3153
EP - 3163
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 25
ER -