Cardiovascular Events Among Adults Treated With Chimeric Antigen Receptor T-Cells (CAR-T)

Raza M. Alvi, Matthew J. Frigault, Michael G. Fradley, Michael D. Jain, Syed S. Mahmood, Magid Awadalla, Dae Hyun Lee, Daniel A. Zlotoff, Lili Zhang, Zsofia D. Drobni, Malek Z.O. Hassan, Emmanuel Bassily, Isaac Rhea, Roohi Ismail-Khan, Connor P. Mulligan, Dahlia Banerji, Aleksandr Lazaryan, Bijal D. Shah, Adam Rokicki, Noopur RajeJulio C. Chavez, Jeremy Abramson, Frederick L. Locke, Tomas G. Neilan

Research output: Contribution to journalArticlepeer-review

140 Scopus citations


Background: Chimeric antigen receptors redirect T cells (CAR-T) to target cancer cells. There are limited data characterizing cardiac toxicity and cardiovascular (CV) events among adults treated with CAR-T. Objectives: The purpose of this study was to evaluate the possible cardiac toxicities of CAR-T. Methods: The registry included 137 patients who received CAR-T. Covariates included the occurrence and grade of cytokine release syndrome (CRS) and the administration of tocilizumab for CRS. Cardiac toxicity was defined as a decrease in the left ventricular ejection fraction or an increase in serum troponin. Cardiovascular events were a composite of arrhythmias, decompensated heart failure, and CV death. Results: The median age was 62 years (interquartile range [IQR]: 54 to 70 years), 67% were male, 88% had lymphoma, and 8% had myeloma. Approximately 50% were treated with commercial CAR-T (Yescarta or Kymriah), and the remainder received noncommercial products. CRS, occurring a median of 5 days (IQR: 2 to 7 days) after CAR-T, occurred in 59%, and 39% were grade ≥2. Tocilizumab was administered to 56 patients (41%) with CRS, at a median of 27 h (IQR: 16 to 48 h) after onset. An elevated troponin occurred in 29 of 53 tested patients (54%), and a decreased left ventricular ejection fraction in 8 of 29 (28%); each occurred only in patients with grade ≥2 CRS. There were 17 CV events (12%, 6 CV deaths, 6 decompensated heart failure, and 5 arrhythmias; median time to event of 21 days), all occurred with grade ≥2 CRS (31% patients with grade ≥2 CRS), and 95% of events occurred after an elevated troponin. The duration between CRS onset and tocilizumab administration was associated with CV events, where the risk increased 1.7-fold with each 12-h delay to tocilizumab. Conclusions: Among adults, cardiac injury and CV events are common post–CAR-T. There was a graded relationship among CRS, elevated troponin, and CV events, and a shorter time from CRS onset to tocilizumab was associated with a lower rate of CV events.

Original languageEnglish (US)
Pages (from-to)3099-3108
Number of pages10
JournalJournal of the American College of Cardiology
Issue number25
StatePublished - Dec 24 2019
Externally publishedYes


  • cardiovascular events
  • chimeric antigen receptor T cells
  • cytokine release syndrome
  • tocilizumab
  • troponin

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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