The Cardiac Toll of CAR-T Therapy

Document Type

Conference Proceeding

Publication Date

2-1-2026

Publication Title

Transplant Cell Ther

Keywords

adult, aged, atrial fibrillation, cardiovascular disease, cardiovascular risk, chimeric antigen receptor T-cell, chimeric antigen receptor T-cell immunotherapy, comorbidity, complication, conference abstract, drug therapy, dyslipidemia, event free survival, female, heart arrhythmia, heart death, heart failure, heart infarction, hematologic malignancy, human, hyperlipidemia, hypertension, incidence, major clinical study, middle aged, multicenter study, prospective study, retrospective study, risk factor, smoking, survivor, therapy

Abstract

Introduction: CAR-T cell therapy represents a groundbreaking advancement for hematologic malignancies, harnessing autologous T cells to generate targeted cytotoxicity against tumor-specific antigens. While short-term cardiovascular (CV) complications have been documented, long-term CV outcomes remain poorly defined. Objectives: 1. Understand the spectrum of cardiovascular complications associated with CAR-T cell therapy, including both early and late manifestations 2. Identify patient-level predictors of post-CAR-T cardiovascular events, including the role of pre-existing arrhythmia and higher Hematopoietic Cell Transplantation-specific Comorbidity Index (HCT-CI) scores. Methods: We conducted a retrospective multicenter study evaluating the incidence and predictors of cardiac complications after CAR-T therapy. Cardiac events within two years of infusion included new-onset hypertension, myocardial infarction, heart failure, arrhythmia, atrial fibrillation, dyslipidemia, or a ≥10% decline in LVEF to ≤50%, and death due to cardiac causes. Cumulative incidence was estimated using the cumulative incidence function (CIF), accounting for non-cardiac deaths as competing events. A 6-month landmark analysis examined late complications among patients alive and event-free at six months post-infusion. Results: Among 68 patients, 26 (38.2%) developed a cardiac complication within 2 years. No pre-existing CV risk factors, including hypertension, diabetes, smoking, or hyperlipidemia, were significantly associated with post-CAR-T events. Higher HCT-CI scores correlated with greater risk (p = 0.008). Among 33 patients alive and event-free at 6 months, 5 (15.1%) experienced a cardiac complication by 2 years. Prior arrhythmia was significantly associated with subsequent cardiac complications (yes=60% vs no=10.7%, p = 0.031), and a trend was observed for atrial fibrillation (yes=40% vs no=7.1%, p = 0.10). As shown in Figure 1, most cardiac events occurred within the first six months after infusion, while late-onset complications were infrequent. Among six-month survivors, the cumulative incidence of cardiac events remained low compared with non-cardiac deaths (18% vs 30% at 18 months). Conclusions: Long-term cardiac complications after CAR-T therapy seem rare among patients who survive beyond six months, although pre-existing arrhythmia might identify those at higher risk for future events. Due to the smaller-than-anticipated cohort, this study offers preliminary, unadjusted estimates aimed at guiding future research design. Larger prospective studies are necessary to confirm these results.

Volume

32

Issue

2

First Page

S364

Last Page

S365

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