CAR-T recipients require ‘fair amount’ of health care resources after treatment
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Nearly 40% of patients who received chimeric antigen receptor T-cell therapy required hospitalization for disease- or treatment-related reasons in the year after infusion, results of a research letter in JAMA Oncology showed.
More than one in five CAR-T recipients required at least one ED visit in the year after treatment, leading to investigators to conclude that certain high-risk subgroups may require intensive health care utilization after therapy.
Background
The relative novelty of CAR T-cell therapy means most outcomes studies have been conducted in clinical trial settings. This may not always be an accurate predictor of how patients will respond to or tolerate a therapy in real-world settings, according to Smita Bhatia, MD, director of Institute for Cancer Outcomes & Survivorship at University of Alabama at Birmingham School of Medicine, associate director of UAB’s O'Neal Comprehensive Cancer Center and a HemOnc Today editorial board member.
“Led by my colleague and co-author, Kelly M. Kenzik, PhD, our group wanted to observe the real-world experience in terms of health care utilization among patients who have been treated with cellular therapy,” Bhatia told Healio. “We wanted to know the likelihood of rehospitalization or need for emergency department services so that patients and other health care providers involved in the process would have some real-world evidence about what to expect.”
Methodology
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.
Investigators 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, whereas 7.6% had chronic lymphocytic leukemia and 24.2% had either multiple myeloma or an unspecified cancer diagnosis.
Researchers tracked CAR-T recipients’ subsequent rehospitalizations or ED visits in the 12 months after final discharge following CAR-T infusion, or until patients received additional chemotherapy, lost their insurance coverage or died.
Median post-infusion follow-up was 6.5 months, with a data cutoff date of Dec. 31, 2019.
Key findings
Eighty-three patients (39.3%) required a combined 145 incidents of rehospitalization within 12 months of hospital discharge after CAR-T infusion; thirty-five (42.2%) of those patients required two or more hospitalizations during that period.
The most common reasons for rehospitalization included symptoms related to primary disease or treatment-related adverse effects (26.1%), followed by infection (19.7%).
Rehospitalization after CAR-T peaked in the 30 days after discharge, with a rate of 0.23 per person-month. The rehospitalization rate declined to 0.08 per person-month at 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, with a total 64 visits over the study period.
Approximately 29% of patients visited the ED two or more times.
The most frequent reasons for ED visits included symptoms related to primary disease (42.2%), infection (20.3%) and pain (10.9%).
Clinical implications
“These results show there is a fair amount of rehospitalization and emergency department visits after CAR-T, most of which occurs in the first 30 days,” Bhatia said.
The investigators looked at whether CAR-T product type influenced the outcomes but they found no such relationship, she said.
Researchers acknowledged study limitations, including the inclusion only of 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 utilize additional health care resources after CAR-T, Bhatia said.
“[The] results stress the need for clinicians to prepare patients for the possibility of subsequent hospitalization at the time of CAR-T discharge and the risk for infection,” Bhatia told Healio. “[They] bring into question whether clinicians should put patients on prophylactic antimicrobial treatment for the first 90 days after discharge to help reduce the rate of rehospitalization driven by infections.”
For more information:
Smita Bhatia, MD, MPH, can be reached at sbhatia@uab.edu.
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Kenzik KM, et al. JAMA Oncol. 2022;doi:10.1001/jamaoncol.2022.1044.
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