Cardiovascular complications and their association with short‐ and long‐term outcomes in patients with multiple myeloma undergoing chimeric antigen receptor T‐cell therapy

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Summary: Studies of cardiovascular (CV) events after chimeric antigen receptor T‐cell (CAR‐T) therapy have mostly focused on patients with lymphoma. We evaluated the incidence, timing and prognostic significance of in‐hospital and post‐discharge CV events in patients with multiple myeloma (MM) receiving CAR‐T therapy. We conducted a retrospective analysis of MM patients treated with CAR‐T between 2018 and 2024. CV events (heart failure, arrhythmias, myocardial infarction and stroke) and all‐cause mortality were assessed separately during hospitalization and post‐discharge. Time‐dependent Cox regression was used to evaluate associations with mortality. Among 256 patients, 11.7% ( n = 30) experienced in‐hospital CV events, most commonly atrial arrhythmias (5.5%) and new left ventricular (LV) dysfunction (3.9%), with a median onset of 8 (Q1, Q3: 5, 11) days. Ninety percent of those with LV dysfunction recovered function. Independent predictors of in‐hospital CV events included age >65, prior atrial fibrillation, antiplatelet use, cytokine release syndrome grade ≥2 and higher immune effector cell‐associated neurotoxicity syndrome grade. Post‐discharge CV events were less common (7.8%), occurring at a median of 13 (Q1, Q3: 7, 22) months. Only post‐discharge CV events were associated with higher post‐discharge all‐cause mortality. There were no in‐hospital CV deaths and one post‐discharge CV death. In this large MM CAR‐T cohort, in‐hospital CV events were relatively uncommon, reversible and not linked to mortality. In contrast, post‐discharge CV events, while rare, predicted worse survival.

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