Chimeric antigen receptor T-cell therapy related cardiovascular adverse effects: A National Inpatient Sample study.

Abstract

e24025 Background: With the expansion of Chimeric Antigen Receptor T-Cell (CAR-T) Therapy in hematologic malignancies, significant treatment adverse effects have been observed. The exploration of cardiovascular effects has been limited due to a paucity in the number of patients in previous studies. This study analyzes CAR-T Therapy related cardiovascular toxicities with a nation-wide dataset, the National Inpatient Sample (NIS) of the United States. Methods: NIS 2022 data were used to analyze the frequency of cardiovascular adverse events in patients aged 18 years and older. In subgroup analysis, relapsed acute lymphoblastic leukemia (ALL) and multiple myeloma (MM) patients were included in the analysis using the International Classification of Diseases (ICD)-10 code. The primary outcomes are the frequency of cardiovascular adverse effects, including arrhythmia, stroke, heart failure (HF), and cardiac arrest. Results: A total of 763 patients received CAR-T Therapy in NIS 2022. MM showed the highest incidence among disease types (24.25%). The distribution was as followed: Diffuse large B-Cell lymphoma (DLBCL) (9.17%), ALL (7.47%), follicular B cell lymphoma (2.36%), acute myeloblastic leukemia (AML) (1.83%), and mantle cell lymphoma (0.92%). In the relapsed ALL subgroup, the rate of atrial fibrillation and atrial flutter was significantly higher in the patients who received CAR-T Therapy compared to those who did not (15% vs 6.43%, p = 0.048). However, MM patients with CAR-T Therapy did not show significant difference in atrial fibrillation and atrial flutter (14.81% vs 19.38%, p = 0.313). The rates of HF, stroke, and cardiac arrest were not significant in the ALL and MM subgroups. Patients with cytokine release syndrome grade 3 or higher were associated with grater incidences of HF and stroke (HF; 16% vs 5.28%, p = 0.047, stroke; 0.81% vs 8%, p = 0.026). Conclusions: To our understanding, this is the first nation-wide study regarding cardiotoxicity in CAR-T Therapy, representing the general patient population in the United States. Relapsed ALL patients who received CAR-T Therapy showed higher rates of arrhythmias, including atrial fibrillation and atrial flutter than those who did not. Further studies in a larger population are warranted. In addition, cardiovascular adverse effects in CAR-T Therapy patients with B cell lymphoma should be further explored. This study underscores the critical need for vigilant cardiovascular monitoring and management in CAR-T Therapy recipients. Further research should elucidate the underlying mechanism of CAR-T Therapy related cardiotoxicity, developing strategies to mitigate the adverse effects.