Case Report: A case of heart failure recovery after non-ischemic cardiomyopathy following chimeric antigen receptor T-cell therapy

TL;DR

A patient experienced heart failure after CAR-T therapy but showed significant recovery over 18 months with proper treatment.

Contribution

This case report highlights the reversibility of CAR-T-induced cardiomyopathy and its management.

Findings

The patient's LVEF dropped to 15% but recovered to 55% over 18 months.

Amiodarone and guideline-directed therapy were effective in managing heart failure and arrhythmias.

The case demonstrates potential for recovery from immunotherapy-induced cardiomyopathy.

Abstract

Chimeric Antigen Receptor T-cell (CAR-T) therapy has emerged as a highly promising immunotherapy for cancer treatment. Intensive research is being conducted focusing on adverse effects that CAR-T infusions may have due to the development of cytokine release syndrome (CRS). We aim to highlight a noteworthy case of ventricular tachycardia presented in the setting of acute non-ischemic cardiomyopathy following CRS after CAR-T therapy, along with providing a detailed discussion of subsequent inpatient and outpatient management.

A 78-year-old man with a past medical history of prostate adenocarcinoma, hypertension, and type two diabetes mellitus, with no prior cardiac history or heart failure, underwent CAR-T therapy for diffuse large B-cell lymphoma (DLBCL). During the same hospitalization, he developed grade one CRS along with asymptomatic non-sustained ventricular tachycardia which was suspected to be bundle branch reentrant tachycardia (BBRT-VT). An echocardiogram performed after CAR-T infusion revealed a reduced left ventricular ejection fraction (LVEF) of 35%, a significant decline from his baseline LVEF of 51% two months prior. After the development of the ventricular tachyarrhythmia, amiodarone was initiated for rhythm control. However, over the subsequent five months, the patient had multiple hospital admissions for heart failure exacerbations. During this period, his EF declined to 15% when he was referred for implantable cardioverter defibrillator (ICD) implantation before gradually improving with continued amiodarone and guideline-directed medical therapy. Over the next 18 months, his LVEF recovered to 55%, highlighting the potential reversibility of immunotherapy-induced cardiomyopathy complicated by ventricular tachyarrhythmia.

This case showcases a prolonged cardiac recovery following complications of CAR-T therapy. It also provides insight into the successful clinical management of a patient due to CAR-T-induced cardiomyopathy in the setting of potentially complex ventricular arrhythmias.

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