Most re-hospitalisations within first month from CAR T-cell infusion

A real-world study from the USA presented at the 63^rd American Society of Hematology 2021 Annual Meeting showed that 45% of the patients were re-hospitalised and 23% of the patients were seen in the emergency department (ED) one or more times during the first year after CAR T-cell infusion [1]. The risks for re-hospitalisation and ED attendance were highest during the first month from infusion.

Chimeric antigen receptor (CAR) T-cell therapy has transformed the treatment landscape for patients with relapsed or refractory (R/R) haematologic malignancies. On the one hand, CAR T-cell therapy is associated with durable remissions in 33% to 40% of the patients with R/R disease. On the other hand, this treatment carries risks of toxicities and re-hospitalisation. Given its relatively recent approval (since 2017), there is limited real-world data on healthcare utilisation after CAR T-cell infusion.

Recent real-world data

Real-world data helps to monitor post-market safety and adverse events (AEs). Furthermore, these studies enable informed regulatory decision-making. In addition, this data is useful for the development of guidelines and can be used by physicians in clinical practice.

Johnson and colleagues (2021) were the first to report real-world data on healthcare and end-of-life outcomes among patients receiving CAR T-cell therapy [2]. They found that 28% of the patients underwent re-hospitalisation within 3 months of CAR T-cell infusion at a median of 18 days. The reasons for these re-hospitalisations included symptoms and toxicity (57.4%), infections and neutropenia (17.2%), and cancer progression (12.5%). “While this study was the first of its kind, it only covered 3 months of post-infusion healthcare utilisation and end-of-life outcomes. Moreover, the study was limited to two institutions,” Dr Kelly Kenzik (Institute for Cancer Outcomes and Survivorship, University of Alabama, Birmingham, USA) said. “This leaves a gap in the evidence for real-world data regarding long-term health care utilisation in recipients of CAR T-cell therapy.”

(Re)hospitalisations

Dr Kenzik and others aimed to examine (re)hospitalisations and ED visits during the first year after CAR T-cell infusion. Secondly, they examined factors associated with re-hospitalisation and ED visits. To identify commercially insured patients who received CAR T-cell infusion at age <65 years, they used the Truven Health MarketScan database, one of the largest private health insurance claims datasets in the USA.

In total, 204 patients on CAR T-cell therapy were followed with a median duration of 3.2 months. Re-hospitalisation occurred in 44% of the patients within the first year after CAR T-cell infusion. Furthermore, 25% of the study population visited the ED in this period. The most prevalent reasons for hospitalisation included infections (41.3%), myelosuppressions (19.9%), and management of underlying malignancies (18.3%). The average length of stay per hospitalisation was highest for infections (13.5 days), followed by management of underlying malignancies (8.3 days), and myelosuppressions (5.9 days).

In the first year after infusion, 12.5% of the study population experienced >2 re-hospitalisations, and 6% experienced ≥2 ED visits.

Conclusions and future

Despite the small study population, there are high-risk subgroups among CAR T-cell receivers with higher healthcare utilisation. Re-hospitalisations and ED visitations were primarily concentrated within the first 30 days after CAR T-cell infusion. Future research is needed to identify high-risk subpopulations to help inform management strategies to mitigate unplanned healthcare utilisation.

1. 
   
   1. Kenzik K, et al. Hospitalizations and Emergency Department (ED) Visits after CAR-T Therapy - Real World Experience in Commercially Insured Patients. 569, ASH 2021 Annual Meeting, 11-14 Dec.
   2. Johnson PC, et al. J Natl Compr Canc Netw. 2021;19:928-934.

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Posted on 4 February, 202210 March, 2022