NOVEL IMMUNOTHERAPIES (CAR-T, BiTE)

Diagnosis

Mr. HW is a 58-year-old African American male who was diagnosed with relapsed/refractory IgA kappa multiple myeloma (MM) ISS stage II in 2012. He has had hypertension for 17 years that was medically controlled with a standard antihypertensive regimen, as well as steroid-induced diabetes, remote history of pulmonary embolism, right lower extremity deep vein thrombosis, and sickle cell trait. He also had a previous abnormal electrocardiogram with right bundle branch block, and he recently contracted SARS-CoV-2 (+COVID), from which he recovered and later tested negative.

Treatment

Mr. HW has previously received multiple treatments for MM, including combinations of lenalidomide, bortezomib, dexamethasone, thalidomide, pembrolizumab, carfilzomib, pomalidomide, daratumumab, cabozantinib, and cyclophosphamide. Most recently, due to progression of disease, he was initiated on bispecific T-cell engager (BiTE) therapy consisting of two courses of AMG 701. He underwent a successful infusion and was treated medically for intermittent fevers. 

Cardiovascular Toxicity Mitigation and Management

After BiTE therapy infusion, Mr. HW reported symptomatic improvement. However, upon routine nursing assessment, he was found to be unresponsive. Advanced cardiac life support (ACLS) protocol was initiated, and Mr. HW was noted to be in ventricular fibrillation. He was defibrillated four times and initiated on amiodarone per ACLS protocol; however, he did not recover, and expired.

Note: Although there is little data to support any direct cardiac injury linked to AMG 701 at this time, cardiac risk factor modification and pre-cancer treatment screening for underlying cardiac disease are critical steps to avoid any potential cardiac adverse events.