Rao Anjali, Stewart Andrew, Eljalby Mahmoud, Ramakrishnan Praveen, Anderson Larry D, Awan Farrukh T, Chandra Alvin, Vallabhaneni Srilakshmi, Zhang Kathleen, Zaha Vlad G
Division of Cardiology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, United States.
Cardio-Oncology Program, Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX, United States.
Front Cardiovasc Med. 2022 Sep 23;9:932347. doi: 10.3389/fcvm.2022.932347. eCollection 2022.
Chimeric antigen receptor T-cell (CAR T) therapy is a revolutionary personalized therapy that has significantly impacted the treatment of patients with hematologic malignancies refractory to other therapies. Cytokine release syndrome (CRS) is a major side effect of CAR T therapy that can occur in 70-90% of patients, with roughly 40% of patients at grade 2 or higher. CRS can cause an intense inflammatory state leading to cardiovascular complications, including troponin elevation, arrhythmias, hemodynamic instability, and depressed left ventricular systolic function. There are currently no standardized guidelines for the management of cardiovascular complications due to CAR T therapy, but systematic practice patterns are emerging. In this review, we contextualize the history and indications of CAR T cell therapy, side effects related to this treatment, strategies to optimize the cardiovascular health prior to CAR T and the management of cardiovascular complications related to CRS. We analyze the existing data and discuss potential future approaches.
嵌合抗原受体T细胞（CAR T）疗法是一种革命性的个性化疗法，对其他疗法难治的血液系统恶性肿瘤患者的治疗产生了重大影响。细胞因子释放综合征（CRS）是CAR T疗法的主要副作用，70%-90%的患者可能会出现，约40%的患者为2级或更高等级。CRS可导致强烈的炎症状态，引发心血管并发症，包括肌钙蛋白升高、心律失常、血流动力学不稳定和左心室收缩功能降低。目前尚无针对CAR T疗法所致心血管并发症管理的标准化指南，但系统性的实践模式正在形成。在本综述中，我们阐述了CAR T细胞疗法的历史和适应证、与此治疗相关的副作用、在CAR T之前优化心血管健康的策略以及与CRS相关的心血管并发症的管理。我们分析现有数据并讨论未来可能的方法。
