In recent years,
cancer treatment has evolved, and new
therapies have been introduced with significant improvement in prognosis. The
immunotherapies stand out owing to their efficacy and remission rate.
Chimeric antigen receptor (CAR) T-cell therapy is a part of this new era of
therapies.
Chimeric antigen receptor T-cell
therapy is a form of adoptive cellular
therapy that uses a genetically encoded CAR in modified human T cells to target specific
tumor antigens in a nonconventional, non-major histocompatibility complex (MHC)
protein presentation.
Chimeric antigen receptor T-cell
therapy successfully identifies
tumor antigens and through activation of T cells destroys tumoral cells. It has been found to efficiently induce remission in patients who have been previously treated for B-cell
malignancies and have persistent disease. As the use of this novel
therapy increases, its potential side effects also have become more evident, including major complications like
cytokine release syndrome (CRS) and
immune effector cell-associated neurotoxicity syndrome (ICANS).
Cytokine release syndrome is a major systemic inflammatory process as a result of massive
cytokine production by the proliferating and activated CAR T cells in which multiple
interleukins and immune cells contribute to the inflammatory response.
Cytokine release syndrome has been associated with cardiovascular life-threatening complications including
hypotension,
shock,
tachycardia, arrhythmias,
left ventricular dysfunction,
heart failure, and cardiovascular death. Arrhythmias, among its major complications, vary from asymptomatic prolonged corrected QT interval (QTc) to
supraventricular tachycardia,
atrial fibrillation, flutter, and ventricular arrhythmias like
Torsade de pointes. This article focuses on the cardiovascular complications and arrhythmias associated with CRS and CAR T-cell therapy.