Case Report: Cardiac Tamponade in Association With Cytokine Release Syndrome Following CAR-T Cell Therapy

Moriyama, Shuji; Fukata, Mitsuhiro; Yamaguchi, Taku; Ueno, S.; Nunomura, Takuya; Mori, Yasuo; Katô, Kôji; Miyamoto, Toshihiro; Akashi, Koichi

doi:10.3389/fcvm.2022.848091

Cited by 7 publications

(10 citation statements)

References 25 publications

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“…One important finding from our case report and that of Moriyama et al ( 9 ), is that both patients initially presented a pericardial localization of the lymphoma. Therefore, we should consider a pre-existing pericardial localization of the lymphoma as a major risk factor for CAR-T cell therapy-induced pericardial effusion with cardiac tamponade.…”

Section: Discussionsupporting

confidence: 75%

“…To our knowledge, cardiac tamponade in association with CRS following CAR-T cell therapy has only been reported once. Indeed, Moriyama et al ( 9 ) reported the case of a 59-year-old man with refractory DLBCL who was also treated with CAR-T cell therapy and who presented cardiac tamponade associated with grade 4 CRS. However, these authors did not perform pericardiocentesis in their patient who had severe myelosuppression and shock, which they considered a major risk factor for complications ( 9 ).…”

Section: Discussionmentioning

confidence: 99%

“…Indeed, Moriyama et al ( 9 ) reported the case of a 59-year-old man with refractory DLBCL who was also treated with CAR-T cell therapy and who presented cardiac tamponade associated with grade 4 CRS. However, these authors did not perform pericardiocentesis in their patient who had severe myelosuppression and shock, which they considered a major risk factor for complications ( 9 ). The management of their patient, who died 6 months after starting CAR-T cell therapy, was based on anti-inflammatory therapy with tocilizumab and corticosteroids and hemodynamic support as recommended for severe CRS ( 13 ).…”

Section: Discussionmentioning

confidence: 99%

“…In this group, pericardial complications account for less than 1% of all CVAE and are therefore very little known ( 6 ). Furthermore, to our knowledge, only one case of cardiac tamponade with CAR-T cell-associated CRS has been reported ( 9 ). Therefore, we report here a case of CAR-T cell-induced CRS complicated with acute pericardial effusion and cardiac tamponade requiring urgent pericardiocentesis.…”

Section: Introductionmentioning

confidence: 99%

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Case report: CAR-T cell therapy-induced cardiac tamponade

Sarfati

Norbert

Hérault

et al. 2023

Front. Cardiovasc. Med.

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CD19-specific chimeric antigen receptor T (CAR-T) cell therapy has recently been shown to improve the prognosis of refractory diffuse large B-cell lymphoma (DLBCL). However, CAR-T cells may induce numerous adverse events, in particular cytokine release syndrome (CRS) which is frequently associated with cardiovascular manifestations. Among the latter, acute pericardial effusion represents less than 1% of cases and cardiac tamponade has only been reported once. The management and outcome of these severe complications are not well established. We report here, a case of cardiac tamponade associated with CRS in a context of CAR-T cell therapy, which required urgent pericardiocentesis.Case summaryA 65-year-old man with refractory DLBCL was treated with CAR-T cell therapy. He had a history of dilated cardiomyopathy with preserved ejection fraction and transient atrial fibrillation. A pericardial localization of the lymphoma was observed on the second relapse. One day after CAR-T cell infusion the patient was diagnosed with grade 1 CRS. Due to hypotension, he was treated with tocilizumab and dexamethasone, and then transferred to intensive care unit (ICU). Echocardiography performed at ICU admission showed acute pericardial effusion with signs of right ventricular heart failure due to cardiac tamponade. It was decided to perform pericardiocentesis despite grade IV thrombocytopenia in a context of aplasia. Analysis of pericardial fluid showed a large number of lymphoma cells and 73% of CAR-T cells amongst lymphocytes, a level that was similar in blood. Hemodynamic status improved after pericardiocentesis, and no recurrence of pericardial effusion was observed. The presence of a high count of activated CAR-T cells in the pericardial fluid as well as the short interval between CAR-T cells injection and the symptoms appear as potential arguments for a direct action of CAR-T cells in the mechanism of this adverse event. The patient was discharged from ICU after two days and initially exhibited a good response to DLBCL treatment. Unfortunately, he died fifty days after starting CAR-T cell therapy due to a new DLBCL relapse.ConclusionPatients with a pericardial localization of DLBCL should be assessed for a risk of cardiac tamponade if receiving CAR-T cell therapy and presenting CRS. In this case, cardiac tamponade seems directly related to CAR-T cell expansion. Pericardiocentesis should be considered as a feasible and effective treatment if the risk of bleeding is well controlled, in association with anti-IL6 and corticosteroids.

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Section: Discussionsupporting

confidence: 75%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Case report: CAR-T cell therapy-induced cardiac tamponade

Sarfati

Norbert

Hérault

et al. 2023

Front. Cardiovasc. Med.

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“…The impact of CAR T cell therapy on the cardiovascular system manifests as hemodynamic compromise, myocardial injury/dysfunction, and/or cardiac arrhythmias (60, 61). There is also the potential for pericardial complications, such as in a case report (62) describing a patient with high-grade lymphoma who developed a pericardial effusion and tamponade with cardiogenic shock after CAR T therapy. Higher-grade CRS appears to be linked to adverse cardiovascular events of all types.…”

Section: Cardiovascular Complications Of Cellular Imunotherapiesmentioning

confidence: 99%

Cardiovascular disease and chimeric antigen receptor cellular therapy

Rao

Stewart

Eljalby

et al. 2022

Front. Cardiovasc. Med.

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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.

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Axicabtagene-ciloleucel/tocilizumab

2022

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Case Report: Cardiac Tamponade in Association With Cytokine Release Syndrome Following CAR-T Cell Therapy

Cited by 7 publications

References 25 publications

Case report: CAR-T cell therapy-induced cardiac tamponade

Case report: CAR-T cell therapy-induced cardiac tamponade

Cardiovascular disease and chimeric antigen receptor cellular therapy

Axicabtagene-ciloleucel/tocilizumab

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