Author + information
- Raza M. Alvi,
- Syed Mahmood,
- Malek Z.O. Hassan,
- Magid Awadalla,
- Lili Zhang,
- Connor P. Mulligan,
- Adam Rokicki,
- Noopur Raje,
- Jeremy Abramson,
- Matthew J. Frigault and
- Tomas G. Neilan
Chimeric antigen receptor T-cells (CAR-T) are gene modified and ex-vivoexpanding autologous T cells designed to recognize and attack a specific cell surface antigen; CAR-T has demonstrated significant promise in treating patients with several relapsed or refractory hematologic malignancies. There are limited data on the cardiovascular effects of CAR-T.
We performed a retrospective single center review of all 82 patients who received CAR-T between Jan 2016 and Jun 2018. Cardiovascular testing was performed at the discretion of the primary attending and was not pre-specified. Data of interest included measures of left ventricular ejection fraction and cardiac troponin. The outcome of interest included cardiovascular (CV) events defined as a combination of arrhythmia, heart failure exacerbation, cardiogenic shock, and CV death.
Of the 82 patients, 66 (80%) received CAR-T for diffuse large B-cell lymphoma, 11 (13%) for multiple myeloma and 5 (7%) for other cancers. The mean age of the cohort was 60±11 years and included 69% males, 8% diabetics, 31% with hypertension, 6% with a history of coronary artery disease, 2% with a history of heart failure (HF), and 5% with a history of arrhythmias. Among these 82 patients, 36 had troponin measured pre- and post-CAR-T, 21 of the 36 (58%) had a significant increase in troponin with CAR-T. Similarly, 19 of 82 had an echocardiogram pre-and post-CAR-T, of whom 4 had a new reduction in ejection fraction (21%). Patients with a post-CAR-T increase in troponin had higher pre-CAR-T left ventricular (LV) mass, larger LV dimensions and an increased left atrial size compared to those who did not have an increase in troponin with CAR-T. In follow-up, there were 8 cardiovascular events (10%, new arrhythmias (n=6), and cardiogenic shock leading to death (n=2)). Among patients with cardiovascular events, serum troponin was elevated among all prior to that event.
An elevation is serum troponin is common among patients treated with CAR-T, is associated with pre-existing cardiac structural abnormalities and associated with subsequent cardiovascular events.
Poster Hall, Hall F
Saturday, March 16, 2019, 10:00 a.m.-10:45 a.m.
Session Title: Heart Failure and Cardiomyopathies: Clinical 1
Abstract Category: 13. Heart Failure and Cardiomyopathies: Clinical
Presentation Number: 1144-528
- 2019 American College of Cardiology Foundation