Lung issues associated with CAR-T

Lung issues associated with CAR-T therapy should cause alarm to any MM patient considering this therapy. I am focusing on multiple myeloma because I am a MM survivor, coach and hoping to bring attention to side effects associated with CAR-T therapy.

Yes, CAR-T therapy has a lot going for it. And MM survivors looking to take advantage of this therapy are often late stage MM patients with few therapy choices hoping for a long-term remission.

This blog post, as well as the other blog posts on PeopleBeatingCancer.org that focus on adverse events associated with CAR-T therapy, is more about educating MM patients as well as exploring possible side effect prevention strategies.

The last paragraph in the linked article mentions “preconditioning drugs.” Until I learn otherwise, I am going to broaden that phrase to be “preconditioning therapies” meaning that I am adding any/all therapies shown to strengthen lung function.

What therapies have the ability to strengthen lung function?

Breathing Exercises

Diaphragmatic Breathing: Encourages deeper, more efficient breaths by engaging the diaphragm. This technique can improve lung capacity and oxygenation.
Pursed-Lip Breathing: Helps to keep airways open longer, reducing shortness of breath and improving oxygen exchange.
Deep Breathing Exercises: Regular deep breathing can increase lung capacity and strengthen respiratory muscles.

2. Pulmonary Rehabilitation

A structured program combining exercise, education, and support for people with chronic respiratory issues like COPD. It typically includes supervised exercises to improve lung function and endurance.

3. Inspiratory Muscle Training (IMT)

Uses devices that create resistance during inhalation, strengthening the muscles involved in breathing. IMT can increase lung capacity and improve breathing efficiency.

4. Physical Exercise

Regular cardiovascular exercise, such as walking, swimming, or cycling, can improve overall lung function. Exercise increases oxygen uptake and strengthens the respiratory muscles.

5. Oxygen Therapy

For those with severe lung disease, supplemental oxygen can help reduce the work of breathing and improve exercise tolerance, indirectly aiding lung function over time.

6. Medications

Bronchodilators: Relax the muscles around the airways, improving airflow and lung function.
Anti-inflammatory Drugs: Reduce inflammation in the airways, helping to keep them open and functional.
Mucolytics: Help to clear mucus from the lungs, improving airflow.

7. Chest Physiotherapy (CPT)

Techniques such as percussion, vibration, and postural drainage help clear mucus from the lungs, enhancing lung function and preventing infections.

8. Diet and Nutrition

A diet rich in antioxidants and anti-inflammatory foods can support lung health. Proper hydration also helps to thin mucus, making it easier to expel.

9. Smoking Cessation

Quitting smoking is crucial for improving lung function, particularly for individuals with chronic lung conditions. Smoking cessation can slow the decline in lung function and improve respiratory health.

10. Environmental Control

Reducing exposure to pollutants, allergens, and irritants can prevent further damage to the lungs and help maintain or improve lung function.

11. Postural Techniques

Certain body positions can improve lung expansion and oxygenation, such as lying on your side or practicing forward-bending postures in yoga.

12. Vaccinations

Vaccinations against flu and pneumonia can prevent respiratory infections that may worsen lung function, especially in vulnerable populations.

13. Use of Air Filters and Humidifiers

Maintaining good indoor air quality with filters and humidifiers can reduce respiratory irritants and allergens, supporting lung function.

I believe that most every cancer patient experiences most every side effect. It is only the percentage of patients who are dramatically affected by a side effect that actually report it.

Quiting smoking ought to be a requirement for all who want to avoid lung issues associated with CAR-T therapy.

Having every patient who is about to undergo CAR-T therapy spend a week or so exercise, practice lung strengthening exercises, install air filters in their home before they undergo CAR-T therapy, etc. would benefit, especially, those patients who are most suseptible to lung issues associated with CAR-T therapy.

Email me at David.PeopleBeatingCancer@gmail.com if you would like to learn more about MM- both conventional and non-conventional therapies.

thank you,

David Emerson

MM Survivor
MM Cancer Coach
Director PeopleBeatingCancer

CAR-T therapy pulmonary adverse event profile: a pharmacovigilance study based on FAERS database (2017–2023)

“Chimeric antigen receptor T-cell (CAR-T) therapy, a rapidly emerging treatment for cancer that has gained momentum since its approval by the FDA in 2017, involves the genetic engineering of patients’ T cells to target tumors. Although significant therapeutic benefits have been observed, life-threatening adverse pulmonary events have been reported…

Results: The FAERS database recorded 9,400 adverse events (AEs) pertaining to CAR-T therapies, of which 940 (10%) were PAEs.

Among these CAR-T cell-related AEs,

hypoxia was the most frequently reported (344 cases),
followed by respiratory failure (127 cases).

Notably, different CAR-T cell treatments demonstrated varying degrees of association with PAEs. Specifically,

Tisa-cel was associated with severe events including respiratory failure and hypoxia,
whereas Axi-cel was strongly correlated with both hypoxia and tachypnea.

Additionally, other CAR-T therapies, namely, Brexu-cel, Liso-cel, Ide-cel, and Cilta-cel, have also been linked to distinct PAEs. Notably, the majority of these PAEs occurred within the first 30 days post-treatment. The fatality rates varied among the different CAR-T therapies, with Tisa-cel exhibiting the highest fatality rate (43.6%), followed by Ide-cel (18.8%).

Conclusion: This study comprehensively analyzed the PAEs reported in the FAERS database among recipients of CAR-T cell therapy, revealing conditions such as

hypoxia,
respiratory failure,
pleural effusion,
and atelectasis.

These CAR-T cell therapy-associated events are clinically significant and merit the attention of clinicians and researchers…

Fatality proportion

Figure 7 shows the fatality rates of PAEs following CAR-T cell therapy. According to database statistics,

Tisa-cel had the highest number of deaths (160 out of 367 cases, 43.6%) and
Axi-cel had the highest incidence of PAEs (406 cases)

among all CAR-T therapies, with 141 patients (34.7%) experiencing death. Among the 32 cases of PAEs associated with Ide-cel, only six resulted in death, representing the lowest mortality rate of 18.8%. The mortality rates of the PAEs associated with Brexu-cel and Liso-cel were 28.0% and 33.3%, respectively.

Finally, Cilta-cel had 26 cases of PAEs related to it, of which 13 resulted in death, with a mortality rate of 50%. Because of the short time since its market release and the limited overall sample size, the relatively high fatality rate observed may be influenced by “small sample bias…”

Conclusion

This study comprehensively described the PAEs reported in the FAERS database for patients receiving CAR-T cell therapy, including conditions such as hypoxia, respiratory failure, pleural effusion, and atelectasis.

These events are associated with a higher incidence and risk in patients undergoing CAR-T cell therapy, can severely impact breathing, and are life-threatening.

To minimize these risks, physicians should consider preconditioning drugs, fine-tune CAR-T doses, and alternative treatment plans. Lung issues associated with CAR-T therapy are clinically significant and require attention from both doctors and researchers.”

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