{"id":"71a1dd50bdc3","type":"article","url":"https://hartvaat.nl/2026/05/26/car-t-therapie-bij-ouderen-5-8-mace-en-sterk-verhoogde-mortaliteit-cardio-oncolo/","title":"CAR-T-therapie bij ouderen: 5,8% MACE en sterk verhoogde mortaliteit — cardio-oncologie attent","title_en":"","category":"algemeen","category_label":"Algemeen","professions":["cardioloog","internist"],"tags":["kanker-en-hart"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehag394","source_url":"https://doi.org/10.1093/eurheartj/ehag394","authors":["Raja Zaghlol","Elena Deych","Daniel A Ladin","David A Russler-Germain","Walter Schiffer","Nischit Baral","R J Waken","Bonnie Ky","Karen E Joynt Maddox","Joshua D Mitchell"],"significance":6,"published":"2026-05-30","source_date":"2026-05-26","image":"","kennis":["https://hartvaat.nl/kennis/cardiometabool/diabetes-en-cardiovasculair-risico/","https://hartvaat.nl/kennis/cardiometabool/obesitas-en-hart/"],"congress":"","summary_en":"Retrospective cohort of 3,292 Medicare beneficiaries aged >65 who received CAR-T therapy for relapsed haematologic malignancies between 2018 and 2023. Major adverse cardiovascular events occurred in 5.8%, mainly acute heart failure (3.1%) and ischaemic (1.3%) or haemorrhagic stroke (1%). Pre-treatment atrial fibrillation (aOR 1.52), cardiomyopathy (aOR 2.49), and cerebrovascular disease (aOR 2.40) were independent predictors. MACE was associated with markedly elevated in-hospital mortality (aOR 16.9) and 1-year mortality (HR 1.91). Findings underscore the need for cardiovascular screening and monitoring in oncological immunotherapy.","created":"2026-07-03T10:32:58Z","updated":"2026-07-03T13:31:53Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Retrospectieve cohortstudie van 3.292 Medicare-patiënten >65 jaar die tussen 2018 en 2023 CAR-T-therapie ondergingen voor recidiverende hematologische maligniteiten. Major adverse cardiovascular events (MACE) traden op bij 5,8%, voornamelijk acuut hartfalen (3,1%) en ischemisch (1,3%) of hemorragisch CVA (1%). Onafhankelijke risicofactoren waren pre-existent atriumfibrilleren (aOR 1,52), cardiomyopathie (aOR 2,49) en cerebrovasculaire ziekte (aOR 2,40). MACE was geassocieerd met sterk verhoogde in-hospital mortaliteit (aOR 16,9) en 1-jaars mortaliteit (HR 1,91). De bevindingen onderstrepen de noodzaak van cardiovasculaire screening en monitoring bij oncologische immuuntherapie.","abstract_original":"BACKGROUND AND AIMS: Chimeric antigen receptor T-cell (CAR-T) therapies are cellular immunotherapies that improve survival in patients with relapsed haematologic malignancies. However, their association with major adverse cardiovascular events (MACE) has received limited study, particularly in older adults. This study investigated the incidence of MACE, associated risk factors, and their impact on survival among older patients undergoing CAR-T in the USA. METHODS: Medicare fee-for-service beneficiaries over 65 who received inpatient CAR-T therapy between 2018 and 2023 were included. Baseline characteristics were assessed during the 12 months preceding CAR-T. MACE were defined as a composite of acute heart failure (HF), cardiogenic shock, myocardial infarction, cardiac tamponade, ventricular arrhythmia, complete heart block, or stroke. Multivariable models were adjusted for demographics, malignancy type, and baseline cardiovascular comorbidities. RESULTS: Among 3292 patients receiving CAR-T, 191 (5.8%) had MACE. Most common events were acute HF (3.1%), followed by ischaemic (1.3%) and haemorrhagic stroke (1%). Pre-treatment atrial fibrillation/flutter [adjusted odds ratio (aOR) 1.52 (1.08-2.16)], cardiomyopathy [aOR 2.49 (1.75-3.54)], and cerebrovascular disease [aOR 2.40 (1.30-4.43)] were independently associated with MACE. In 2021-23, MACE were also associated with immune effector cell-associated neurotoxicity syndrome and higher-grade cytokine release syndrome. MACE were associated with higher in-hospital mortality [aOR 16.9 (11.0-26.1)] and 1-year mortality after discharge [adjusted hazard ratio 1.91 (1.46-2.49)]. CONCLUSIONS: In the largest national sample of older adults receiving CAR-T, MACE occurred in 5.8% of patients and were associated with increased in-hospital and 1-year mortality. Further investigation into preventive and mitigating measures is needed."}