Prospective echocardiographic evaluation of systolic and diastolic cardiac function following anti-bcma car-t therapy in patients with multiple myeloma

Background

Multiple myeloma (MM) is a plasma cell malignancy that remains incurable despite recent advances in therapeutic strategies. Anti–B-cell maturation antigen (BCMA) chimeric antigen receptor T-cell (CAR-T) therapy has emerged as a promising treatment for relapsed/refractory MM (RRMM), demonstrating high response rates. We have previously reported prospective data on cardiac function following CAR-T therapy in patients with diffuse large B-cell lymphoma. However, to date, limited prospective study has evaluated changes in cardiac function after CAR-T therapy in patients with MM. The aim of this study was to prospectively investigate sequential changes in cardiac systolic and diastolic function in patients with RRMM treated with anti-BCMA CAR-T therapy.

Methods

This prospective study enrolled 30 patients with RRMM who underwent anti–BCMA CAR-T therapy. Echocardiographic assessments were performed sequentially at four time points: before CAR-T therapy and at 7, 14, and 28 days after treatment. Left ventricular systolic function was evaluated using left ventricular ejection fraction (LVEF) and global longitudinal strain (GLS). Left ventricular diastolic function (LVDD) was assessed using the left atrial volume index (LAVI), mitral E-wave velocity, E/e′ ratio, and tricuspid regurgitation velocity (TRV). The predefined cutoff values were E/e′ > 14, e′ < 7 cm/s, TRV > 2.8 m/s, and LAVI > 34 mL/m². LVDD was diagnosed when more than half of these parameters exceeded the cutoff values, whereas patients meeting one or none of the criteria were classified as having normal diastolic function.

Results

The mean age of the patients was 64.8 years, and 14 patients (47%) were female.

No statistically significant changes in LVEF were observed across the four time points. In contrast, LVGLS showed significant differences between baseline and all post–CAR-T therapy measurement points.

Regarding diastolic function, at baseline, 20 of the 30 patients had normal diastolic function, while 10 patients exhibited intermediate diastolic dysfunction. On echocardiography performed 7 days after CAR-T therapy, the number of patients with normal diastolic function decreased to 16, whereas those with intermediate diastolic dysfunction increased to 13. At 14 and 28 days, diastolic function demonstrated a gradual improvement over time.

Conclusions

This study demonstrated transient reduction in LVGLS and diastolic function was observed at 7 days after CAR-T therapy, whereas no significant change in LVEF was noted. These findings suggest that post–CAR-T therapy–related cardiac dysfunction in MM may be limited and largely reversible. Further studies are warranted to clarify the long-term clinical significance of these observations.