Low cardiovascular event rates in patients treated with CAR T-cells: Real-world outcomes from two independent cohorts.

Abstract

Aims: CAR-T cell therapy is becoming a key pillar of medical oncology, used for an expanding range of indications. Considering the increased risk of cardiovascular disease with increasing age, assessing the impact of cardiac comorbidities can help minimizing complications and improve treatment outcomes.

Methods: We evaluated cardiovascular outcomes in patients undergoing CD19- or BCMA-directed CAR T-cell therapy from two large independent databases (DESTATIS (Germany) and the TriNetX network (US)).

Results: Among 2,545 CAR T-cell cases from Germany and 1,335 patients from the US, we identified 51 respective 20 short-term severe cardiac events with early death documented in 135 (5%) and 16 (1.2%) patients. Patients with preexisting cardiac conditions did not show an increased risk for immune-related complications like cytokine release (OR 1.19, 95%CI 0.77-1.82) or neurotoxicity syndrome (OR 1.59, 95%CI 0.94-2.69). They faced higher long-term risks for major cardiovascular events (OR 1.89, 95%CI 1.23-2.91) and kidney failure (OR 2.98, 95%CI 1.85-4.81).

Conclusion: Cardiovascular complications in CAR T-cell therapy were rare and primarily affected patients with preexisting cardiac conditions. Serious cardiac events were uncommon acutely but increased over time. The analysis underscores the need for risk-adapted follow-up and cardiological assessments to improve outcomes in patients with cardiac comorbidities. Inherent with the databases used, these results should be interpreted with caution, as underreporting and overreporting could introduce bias regarding risik factors and outcomes in both directions.