How I approach optimization of patients at risk of cardiac and pulmonary complication after CAR-T cell therapy.

Chimeric antigen receptor (CAR)-T cells have transformed the care of patients with hematologic malignancies. Patients treated with CAR-T cells may experience cardiovascular and pulmonary complications which primarily occur in the setting of cytokine release syndrome. In addition, many patients considered for CAR-T cell therapy have pre-existing cardiac and pulmonary comorbidities. In patients with good functional status, these conditions should not prevent patients from being offered these life-saving therapies. In this "How I Treat" article, we use a case-based approach to discuss how we evaluate and optimize patients with cardiac and pulmonary risk factors prior to CAR-T cell therapy and how we manage cardiac and pulmonary complications that may arise with treatment.