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Myeloma CAR-T Heart Damage
Myeloma patients who sustain heart damage from CAR-T therapy, as discussed below, are more vulnerable than what the research explains. More vulnerable yet can protect themselves. Let me explain.
I make this statement simply because research shows that MM patients who develop heart disease from chemotherapy, often do so months or years after they undergo cardiotoxic therapies.
I know that because I developed chemotherapy-induced cardiomyopathy fully 15 years after I underwent my ASCT (melphalan, busulphan, cytoxan).
According to the study linked below, over 12% of MM patients who underwent CAR-T cell therapy developed cardiovascular adverse events (CVAD) during the months following their therapy. I am willing to bet that there will be more myeloma patients in this treatment group who develop CVAD as the months pass by.
What non-conventional heart healthy therapies can cancer patients undergo that may protect them from cardiotoxicity?
Coenzyme Q10 (CoQ10) Supplements
- Mechanism: CoQ10 is an antioxidant that helps protect cells, particularly the heart, from damage and supports mitochondrial function.
- Evidence: Some studies suggest that CoQ10 can reduce oxidative stress and improve heart function in patients receiving cardiotoxic chemotherapy, such as doxorubicin. However, its use should always be guided by an oncologist to avoid interference with treatment.
2. Omega-3 Fatty Acids
- Mechanism: Omega-3 fatty acids, found in fish oil, have anti-inflammatory and antioxidant properties, which may protect heart tissue from damage.
- Evidence: Omega-3s have been shown to improve lipid profiles, reduce inflammation, and improve heart rate variability. In cancer patients, they may help mitigate cardiotoxicity from treatments, but they should be carefully monitored due to potential bleeding risks when combined with certain chemotherapies.
3. Exercise and Cardiopulmonary Rehabilitation
- Mechanism: Physical activity can improve heart health by reducing inflammation, improving circulation, and enhancing heart function.
- Evidence: Supervised exercise programs, especially those focusing on aerobic and resistance exercises, can reduce the risk of heart damage in cancer patients, improve treatment tolerance, and reduce fatigue. Exercise has been associated with better cardiovascular outcomes in cancer patients.
4. Mind-Body Practices (Yoga, Tai Chi, Meditation)
- Mechanism: These practices reduce stress and inflammation while improving heart rate variability, which benefits heart health.
- Evidence: Studies suggest that mind-body practices can lower stress hormones and blood pressure, improve heart rate, and reduce overall anxiety and depression in cancer patients, supporting heart health indirectly.
5. Medicinal Mushrooms (e.g., Reishi, Cordyceps)
- Mechanism: Certain mushrooms have antioxidant and immune-modulating effects that may protect tissues, including the heart, from oxidative stress.
- Evidence: Some studies have shown protective cardiovascular effects from medicinal mushrooms, including reduced inflammation and oxidative damage. However, more research is needed, and patients should consult their oncologist before use to avoid potential interactions with chemotherapy.
6. Herbal Adaptogens (e.g., Ashwagandha, Rhodiola, Turmeric)
- Mechanism: Adaptogens help the body resist stress and reduce inflammation.
- Evidence: While research is limited, some adaptogens may protect heart tissue and reduce oxidative damage. For example, ashwagandha and turmeric have shown antioxidant properties that may benefit the cardiovascular system. Consultation with a medical team is essential to avoid interference with cancer treatment.
7. High-Quality Probiotic Supplementation
- Mechanism: Gut health is closely tied to cardiovascular health, and probiotics may help reduce inflammation and support immune function.
- Evidence: Emerging research shows that gut microbiota influence cardiovascular health. Maintaining gut health with probiotics may offer indirect benefits to heart health, especially when chemotherapy can disrupt gut microbiota balance.
8. Acupuncture for Stress Reduction
- Mechanism: Acupuncture may help balance the autonomic nervous system, reduce stress, and support circulation.
- Evidence: Some studies suggest acupuncture can help manage cancer treatment-related symptoms and stress, which can reduce cardiovascular strain.
Important Considerations
- Always consult healthcare providers before introducing any non-conventional therapies, as interactions with cancer treatments can occur.
- Integrative oncology centers are often well-equipped to provide guidance on safe complementary therapies tailored to individual cancer and cardiovascular needs.
I am not a cardiologist or any sort of health professional. I am a long-term MM survivor who developed CIC (afib, hypertension, etc.) and has been able to stabilize or improve all of my heart metrics since my diagnosis in late 2010.
And frankly, I am amazed by the long-term heart benefits of evidence-based non-conventional therapies listed above.
Research over the last 20 or so years has shown me that oncology does a poor job of documenting serious side effects such as chemotherapy-induced cardiomyopathy. And I think oncology is doing this again with heart damage caused by CAR-T cell therapy.
Email me at David.PeopleBeatingCancer@gmail.com with questions about CIC.
Hang in there,
David Emerson
- MM Survivor
- MM Cancer Coach
- Director PeopleBeatingCancer
Cardiovascular Adverse Events After Anti-BCMA CAR-T (Ide-Cel and Cilta-Cel) for Relapsed/ Refractory Multiple Myeloma
Introduction: Idecabtagene vicleucel (Ide-Cel) and ciltacabtagene autoleucel (Cilta-cel) are novel CAR-T therapies targeting B-cell maturation antigen (BCMA) and approved for relapsed and refractory multiple myeloma (RRMM).
While cardiovascular adverse events (CVAE) are relatively common with CD-19 CAR-T, the incidence of CVAE in the real-world setting for anti-BCMA CAR-T in RRMM is largely unknown. This study aims to determine the incidence of CVAE and its associated risk factors in patients treated with ide-cel and cilta-cel.
Method: This single-center retrospective cohort study evaluated RRMM patients treated with ide-cel and cilta-cel from May 2021 to December 2023. We assessed baseline cardiac and oncologic characteristics and clinical outcomes post-CAR-T. Cytokine release syndrome (CRS) and immune cell-associated neurologic syndrome (ICANS) grading followed ASTCT consensus guidelines.
Result: A total of 164 RRMM patients treated with ide-cel (N=109) or cilta-cel (N=55) with at least 6 months follow-up were included. The average age was 63 years, and 57% were male. Advanced RRMM stage (R-ISS III) was present in 17% with a median of 6 prior lines of therapy. CRS grade equal or greater than 2 occurred in 22%, and ICANS grade equal or greater than 3 in 6.7%.
Twenty patients (12.2%) experienced CVAE, including:
- atrial fibrillation (7.9%),
- non-sustained ventricular arrhythmia (3.0%),
- heart failure (3.7%),
- and cardiovascular death (0.6%).
R-ISS III was associated with increased CVAE (52.9% vs. 11.5%; P=0.001). Patients with CVAE had higher baseline ferritin and CRP levels and a higher incidence of CRS grade ≥ 2 (60% vs. 16.7%; P<0.001) and ICANS grade ≥ 3 (20% vs 4.9%; P=0.001). Treatment with tocilizumab, steroids, or anakinra was more common in patients with CVAE.
Conclusion: CVAE occurred relatively frequently following BCMA CAR-T therapy, with high-grade CRS identified as a consistent risk factor. Most CVAEs were manageable with appropriate supportive care, including careful observation and active treatment of CRS.
Myeloma CAR-T Heart Damage Myeloma CAR-T Heart Damage