CAR T cells improve quality of life for majority of recipients
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Patients with hematologic malignancies reported significant improvement in quality of life after receiving chimeric antigen receptor T cells, results from a longitudinal study in Blood Advances showed.
After an initial worsening of quality-of-life (QOL) measures and reported depression in the week following CAR-T infusion, researchers observed overall improvements in QOL, psychological distress and physical symptoms.
However, approximately one-fifth of study participants reported substantial persistent psychological distress and physical symptoms after receiving CAR T cells, the investigators noted.
“We saw major improvements in quality of life and other patient-reported outcomes by the 3-month mark after receiving CAR T cells,” P. Connor Johnson, MD, an oncologist at Massachusetts General Hospital, told Healio. “There is an important subset of patients who do have persistent physical and psychological symptoms, and hopefully we can design some interventions or other therapies to help them improve.”
Background
CAR T cells have become a transformative therapy for patients with advanced hematologic malignancies, according to Johnson.
However, being a novel treatment, little research exists on patient-reported outcomes “through the trajectory of the therapy,” he added.
“Patients often want to know what to expect, understandably, as they go through the treatment process,” Johnson said. “And so, we sought to do prospective study that incorporated a variety of CAR T-cell therapy products — as well as diseases — in order to capture the lived experience and hopefully guide providers in trying to counsel patients and set the stage for even larger, more definitive future studies.”
Methodology
Johnson and colleagues conducted a longitudinal prospective study of 100 adults (median age, 66 years; range, 23-90; 63% men; 87% white) with hematologic malignancies who received CAR T-cell therapy at Massachusetts General Hospital between April 2019 and November 2021.
Most patients treated had lymphoma (71%), followed by multiple myeloma (28%) and B-cell acute lymphoblastic leukemia (1%).
The most frequently used CAR-T products included tisagenlecleucel (Kymriah, Novartis; 34%), lisocabtagene maraleucel (Breyanzi, Bristol Myers Squibb; 16%), axicabtagene ciloleucel (Yescarta, Kite/Gilead; 13%) and idecabtagene vicleucel (Abecma, Bristol Myers Squibb/2seventy bio; 12%).
The investigators assessed QOL using the Functional Assessment of Cancer Therapy-General questionnaire. Additional evaluations included assessments of psychological distress (Hospital Anxiety and Depression Scale, Patient Health Questionnaire-9 and PTSD checklist) and physical symptoms (Edmonton Symptom Assessment Scale-revised).
Researchers conducted assessments at baseline and at several time points after CAR-T infusion, commencing at 6 months after treatment.
Key findings
A longitudinal model analysis showed a significant decrease in patient-reported QOL from baseline to 1 week after CAR-T infusion that returned to baseline value by 1 month after treatment. Reported median QOL scores significantly increased by 3 and 6 months after CAR-T infusion (B = 1.96; 95% CI, 1.23-2.68).
Likewise, depression symptoms increased from baseline to 1 week after CAR-T administration, returning to near baseline at 1 month and showing improvement by 3 and 6 months after infusion.
Symptoms of anxiety and PTSD decreased from baseline to 1 month after CAR-T infusion and remained similar throughout the study period.
A notable proportion of patients reported clinically significant depression (18%), anxiety (22%) and PTSD (22%) symptoms 6 months after CAR-T infusion.
Fifty-two percent of patients reported severe physical symptoms 1 week after CAR-T infusion, which decreased to 28% at 6 months following treatment.
An unadjusted linear mixed model analysis showed an association between increased QOL and worse ECOG performance status (B = 1.24, P = .042) receipt of tocilizumab (B = 1.54, P = .042) and receipt of corticosteroids for cytokine release syndrome or immune effector cell-associated neurotoxicity syndrome (B = 2.05, P = .006).
Clinical implications
The study results provide a guide for clinicians from which they can broadly counsel their patients on what to expect in terms of QOL after receiving CAR T cells, according to Johnson.
“For most patients you can expect that they'll have a dip in quality of life 1 week after CAR T-cell therapy — right in the midst of the acute toxicities,” he told Healio. “But by the 1-month time point those people are back to where they were going, and by the 3-month and 6-month time points, we are seeing that most patients are experiencing quality-of-life improvements.”
Nevertheless, Johnson lamented that nearly one-fifth of patients still report significant psychological symptoms 6 months after CAR-T infusion.
“I think this suggests that there’s room for improvement and that we need additional interventions to improve patient-reported outcomes throughout this whole experience, whether that be supportive care interventions during CAR T-cell treatment, continuing to design strategies to make CAR T cells better, and more well-tolerated and adjunctive medications to minimize the toxicities that patients experience,” Johnson said.
For more information:
P. Connor Johnson, MD, can be reached at Mass General Cancer Center, 55 Fruit St., Yawkey 9A, Boston, MA 02114; email: pcjohnson@mgh.harvard.edu; Twitter @pconnorjohnson.
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