Kenzik KM, et al. JAMA Oncol. 2022; doi: 10.1001/jamaoncol.2022.1044.
Disclosures: Bhatia reported no relevant financial disclosures. Please see the study for the relevant financial disclosures of all other authors.
Nearly 40 percent of patients who received chimeric antigen receptor T-cell therapy required hospitalization for disease- or treatment-related reasons in the year after infusion, a research letter in JAMA Oncology shown
More than one in five CAR-T recipients required at least one ED visit in the year after treatment, leading researchers to conclude that some high-risk subgroups may require intensive health care use after therapy.
The relative newness of CAR T-cell therapy means that most outcome studies have been conducted in clinical trial settings. According to Smita Bhatia, Ph.D., director of the Institute for Cancer Outcomes & Survivorship at the University of Alabama at Birmingham School of Medicine, associate director of UAB’s O’Neal Comprehensive Cancer Center, and a HemOnc today member of the editorial board.
“Led by my colleague and co-author, Kelly M. Kenzik, Ph.D., our group wanted to observe the real-world experience of health care utilization among patients who were treated with cell therapy,” Bhatia told Healio. “We wanted to know the likelihood of re-hospitalization or need for emergency department services so that patients and other health care providers involved in the process would have some real evidence of what to expect.”
Bhatia and colleagues conducted a cohort study of 211 commercially insured patients (median age 55 years; range 1-64) who received either axicabtagene ciloleucel (Yescarta; Kite Pharma, Gilead) or tisagenlecleucel (Kymriah, Novartis) between 2017 and 2019.
Researchers used the Truven Health Analytics MarketScan Commercial Claims and Encounters Database to identify eligible patients.
More than half (68.3%) of patients in the cohort had B-cell lymphoma, while 7.6% had chronic lymphocytic leukemia and 24.2% had either multiple myeloma or an unspecified cancer diagnosis.
The researchers tracked CAR-T recipients’ subsequent readmissions or ED visits in the 12 months following final discharge after CAR-T infusion, or until patients received additional chemotherapy, lost insurance coverage, or died.
Median follow-up after infusion was 6.5 months, with a data cut-off date of December 31, 2019.
Eighty-three patients (39.3%) required a combined 145 rehospitalization events within 12 months of hospital discharge after CAR-T infusion; thirty-five (42.2%) of these patients required two or more hospitalizations during this period.
The most common reasons for rehospitalization included symptoms related to the primary disease or treatment-related adverse reactions (26.1%), followed by infection (19.7%).
Rehospitalization after CAR-T peaks in the 30 days after discharge, at a rate of 0.23 per person per month. The rehospitalization rate decreased to 0.08 per person per month for 90 days.
Multivariate analysis revealed no factors significantly associated with rehospitalization after CAR T-cell therapy.
Forty-five patients (21.3%) visited the ED within 12 months of discharge after CAR-T, for a total of 64 visits during the study period.
Approximately 29% of patients visited the ED two or more times.
The most common reasons for ED visits included symptoms related to the primary disease (42.2%), infection (20.3%), and pain (10.9%).
“These results show that there are quite a few re-hospitalizations and emergency room visits after CAR-T, most of which occur in the first 30 days,” Bhatia said.
The researchers tested whether the type of CAR-T product affected the results, but found no such relationship, she said.
The researchers acknowledged the limitations of the study, including the inclusion of only commercially insured patients.
A larger prospective study that includes patients with public insurance could help identify factors that predict which patients are more likely to use additional health care resources after CAR-T, Bhatia said.
“[The] the results highlight the need for clinicians to prepare patients for the possibility of subsequent hospitalization during CAR-T discharge and the risk of infection,” Bhatia told Healio. “[They] question whether clinicians should place patients on prophylactic antimicrobial therapy during the first 90 days after discharge to reduce infection-induced readmission rates.
For more information:
Smita Bhatia, PhD, MPH, can be reached at [email protected]