CAR-T 细胞疗法中心血管与神经毒性的抢先与预防策略：托珠单抗、阿那白滞素及细胞因子靶向干预的作用

Chimeric antigen receptor T-cell therapy has revolutionized the treatment of hematological malignancies but is associated with significant immune-mediated toxicities, particularly cytokine release syndrome and immune effector cell-associated neurotoxicity syndrome, driven by an exaggerated inflammatory response involving cytokines such as interleukin (IL)-6, IL-1, and tumor necrosis factor-alpha. These processes contribute to endothelial dysfunction and a spectrum of cardiovascular complications, including hypotension, arrhythmias, myocardial dysfunction, and heart failure. The underlying pathophysiology involves complex interactions between immune activation and vascular injury, often progressing rapidly and necessitating early recognition.

Contemporary management is shifting from reactive treatment to proactive strategies, emphasizing early risk stratification using clinical parameters, biomarkers, and imaging, alongside timely intervention with cytokine-directed therapies such as IL-6 and IL-1 inhibitors. Integration of cardiology within multidisciplinary care teams is essential for optimizing outcomes through tailored monitoring and management of cardiovascular complications.

As chimeric antigen receptor T-cell therapy expands to broader and higher-risk populations, including those with pre-existing cardiovascular disease, a structured cardio-oncology approach and further prospective research are critical to improving safety and long-term outcomes.