Readmission rates reaffirm post-CAR-T infusion care policies
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A 14% readmission rate after receipt of axicabtagene ciloleucel supports policies that require monitoring by a caregiver after discharge, according to results of a single-center study presented during the ASCO20 Virtual Scientific Program.
Axicabtagene ciloleucel (Yescarta; Kite Pharma, Gilead), also known as axi-cel, is a chimeric antigen receptor T-cell therapy that targets the CD19 protein on the surface of cancer cells.
At Seattle Cancer Care Alliance, those who receive axi-cel and other CAR T-cell therapies are monitored as inpatients for at least 7 days after infusion. However, the risk for treatment-related complications — including cytokine release syndrome (CRS), neurotoxicity and progressive diseases — can lead to readmission after the minimum monitoring period, according to Paula Perkins, MHS, PA-C, advanced practice provider at Fred Hutchinson Cancer Research Center and Seattle Cancer Care Alliance.
“Patients require full-time caregivers for outpatient monitoring during the period after CAR T-cell infusion,” she told Healio when asked to explain the key takeaway of the study.
Perkins and colleagues conducted a retrospective chart review of 44 patients (median age, 62 years; range, 25-79) who received axi-cel for diffuse large B-cell lymphoma between February 2018 and November 2019. The researchers sought to determine the frequency of patient readmission after initial discharge.
Three quarters (75%) of patients had primary refractory disease and 30% underwent a previous hematopoietic stem cell transplant. Patients had a median three (range, 2-9) lines of therapy before receiving an infusion of axi-cel.
The researchers defined readmission as an inpatient stay greater than 48 hours while being managed by the immunotherapy service at Seattle Cancer Care Alliance. They used logistic regression models to determine any association between readmission and clinical characteristics.
The analysis showed a readmission rate of 14%, with six of 44 patients requiring readmission after initial discharge. One patient was readmitted twice, for a total of seven readmission events.
The median number of days from CAR-T infusion until initial discharge was 14 (range, 7-39) for all patients and those who did not require readmission, and 8.5 days (range, 7-17) for patients who were readmitted.
The most common reasons for readmission were CRS (n = 2) and infection (n = 2), followed by gastrointestinal bleed (n = 1), progressive disease (n = 1) and neurotoxicity (n = 1).
Median day of readmission was 13 (range, 9-25) after initial discharge. Median duration of subsequent hospitalization was 5 days.
Researchers reported overall CRS incidence of 88%, with 12% of patients experiencing either grade 3 or grade 4 CRS. Median time to CRS onset was 3 days (range, 0-13).
Sixty-one percent of patients had neurotoxicity (median time to onset, 6 days; range, 3-14), including 16% with grade 3 or grade 4 neurotoxicity.
Multivariate analysis showed no association between clinical characteristics before or after CAR T-cell infusion and risk for readmission.
The study data support the policy of closely monitoring patients for more than 7 days after CAR T-cell infusion, according to Perkins.
“This study confirms our institutional policy of having a full-time caregiver after initial hospitalization post-CAR-T infusion,” she told Healio.
Perkins said her institution plans to collect data as more patients receive CAR T-cell therapy to “clearly define post-treatment caregiver policies.”
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Perkins P, et al. Abstract 3024. Presented at: ASCO20 Virtual Scientific Program; May 29-31, 2020.
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