High-risk cardiopulmonary comorbidities and considerations before CAR T-cell therapy
| Cardiac comorbidities/risk factors . | Pulmonary comorbidities/risk factors . | Malignancy-related considerations . |
|---|---|---|
| Heart failure, reduced LVEF (<50%), prior or current cardiomyopathy | Moderate-to-severe obstructive or restrictive pulmonary disease | High tumor burden |
| Prior history of myocardial infarction or coronary revascularization | Moderate-to-severe pulmonary hypertension | Product with higher incidence and grade of CRS |
| Cardiovascular risk factors (eg, hypertension, diabetes mellitus, obesity, smoking, prior anthracycline, prior chest radiation) | Recurrent pleural effusions requiring frequent thoracentesis | Rapidly progressive disease (giving less time for optimization) |
| Age >65 y | Large mediastinal masses with concerns of airway involvement | Type of disease (eg, lower rate of toxicity in follicular lymphoma compared with that in diffuse large B–cell lymphoma) |
| Significant valve disease, moderate or greater regurgitation or stenosis | Home oxygen dependency | Intensity of lymphodepletion/conditioning |
| Cardiac comorbidities/risk factors . | Pulmonary comorbidities/risk factors . | Malignancy-related considerations . |
|---|---|---|
| Heart failure, reduced LVEF (<50%), prior or current cardiomyopathy | Moderate-to-severe obstructive or restrictive pulmonary disease | High tumor burden |
| Prior history of myocardial infarction or coronary revascularization | Moderate-to-severe pulmonary hypertension | Product with higher incidence and grade of CRS |
| Cardiovascular risk factors (eg, hypertension, diabetes mellitus, obesity, smoking, prior anthracycline, prior chest radiation) | Recurrent pleural effusions requiring frequent thoracentesis | Rapidly progressive disease (giving less time for optimization) |
| Age >65 y | Large mediastinal masses with concerns of airway involvement | Type of disease (eg, lower rate of toxicity in follicular lymphoma compared with that in diffuse large B–cell lymphoma) |
| Significant valve disease, moderate or greater regurgitation or stenosis | Home oxygen dependency | Intensity of lymphodepletion/conditioning |