Association of cardiovascular toxicities with bispecific antibody therapy in patients with hematologic malignancies: A single-center retrospective analysis.

Abstract

e19014 Background: Bispecific antibodies (bsAbs) are an emerging treatment for hematologic malignancies, but data on cardiovascular (CV) toxicity profile of bsAbs is scarce. Our aim was to assess the incidence, timing, and types of CV toxicities among bsAb-treated patients at the University of Oklahoma Health Sciences Center. Methods: We conducted a single-center retrospective review of 49 adults who received outpatient bsAb therapy for hematologic malignancies at the Stephenson Cancer Center between July 2023 and March 2025. Data on baseline CV comorbidities, biomarkers (BNP, troponin), ICU admissions, and cardiopulmonary interventions were extracted from medical records. Cardiotoxicity was defined as biomarker elevation, new or worsening heart failure, arrhythmia, or ICU-level cardiopulmonary support. Results: Pre-existing CV comorbidities included hypertension (49%), atrial fibrillation/flutter (18%), and heart failure (10%). Cardiopulmonary symptoms included dyspnea (18.4%), peripheral edema (8.2%), chest pain (6.1%), and lower extremity swelling (4.1%). DVT and PE occurred in 4.1% each. New-onset hypertension occurred in 4.1%, and 2.0% had QT prolongation, atrial fibrillation/flutter, supraventricular arrhythmia, ventricular arrhythmia, or heart failure. Single cases (2.0%) were also observed for myocardial infarction, pericardial effusion, heart failure exacerbation, pulmonary edema, DIC, vasculitis, vascular aneurysm/stenosis/rupture, shock, and cardiac arrest. BNP was elevated in 32%, often >2000 pg/mL, typically in the setting of CRS, infection, or volume overload. Troponin elevation occurred in 6%, without clear MI. ICU admissions occurred in 9 of 48 patients (18.8%), with vasopressors used in 5 (10.4%). No patients required invasive mechanical ventilation, and 40% required inpatient cardiopulmonary support (oxygen, BiPAP, or HFNC); none needed new home oxygen at discharge. 2 (4.2%) had cardiology-related hospital admissions. Conclusions: bsAb therapy was associated with a diverse spectrum of CV toxicities, particularly dyspnea, elevated BNP, and cardiopulmonary compromise. Although arrhythmias and troponin-defined myocardial injury were less frequent, they remain clinically relevant. These findings support the need for active cardiovascular surveillance during bsAb treatment, particularly in patients with underlying CV disease.