NOVEL IMMUNOTHERAPIES (CAR-T, BiTE)

Diagnosis and Treatment

Mrs. SK is a 60-year-old female with a history of Philadelphia chromosome–positive T-cell acute lymphoblastic leukemia, currently with relapsed/refractory disease, who was initially treated with steroids and dasatinib and then allogenic stem cell transplantation. Her post-transplant course was complicated by acute renal failure, MRSA bacteremia, and Epstein-Barr virus reactivation. Next she proceeded with treatment including ponatinib and inotuzumab ozogamicin. After showing signs of disease progression, she then moved on to receive her first cycle of blinatumomab, ponatinib, and venetoclax. 

Cardiovascular Toxicity Mitigation and Management

Mrs. SK was admitted to the hospital for dyspnea and was treated for bilateral pneumonia, requiring ICU admission. A cardiology consultation was obtained for treatment of new onset rapid atrial fibrillation with HR 172 bpm. She also experienced transient hypertensive urgency secondary to ponatinib therapy with systolic blood pressure as high as 175/112 mmHg.

Mrs. SK was medically treated with beta blocker therapy in combination with calcium channel blocker therapy. She spontaneously converted to sinus rhythm and maintained good rate control. She was not a suitable candidate for full anticoagulation therapy due to thrombocytopenia with platelet counts as low as 8,000. Mrs. SK’s blood pressure normalized to 110/80s, and she remained stable, from a cardiac standpoint, throughout the remainder of her hospitalization.