Physical function predicts outcomes after CAR-T
- Physical function correlated with outcomes among patients who underwent CAR T-cell therapy.
- Those with worse physical function had higher risk for death and ICANS.
Poor physical function correlated with outcomes among patients with non-Hodgkin lymphoma who underwent chimeric antigen receptor T-cell therapy, according to results of a retrospective cohort study.
Those with poor physical function had higher risk for 1-year mortality, as well as elevated risk for immune effector cell-associated neurotoxicity syndrome (ICANS), findings presented at this year’s Tandem Meetings | Transplantation & Cellular Therapy Meetings of ASTCT and CIBMTR showed.
These associations were independent of CAR-HEMATOTOX scores, a risk-stratification tool often used to identify patients at risk for hematotoxicity.
“We hope to identify patients at risk for these unfavorable outcomes prior to CAR T-cell therapy,” Megan Herr, PhD, associate professor of oncology at Roswell Park Comprehensive Cancer Center, told Healio. “Our goal is to improve outcomes overall for patients with this aggressive form of lymphoma.”
Research on the relationship between poor physical function, non-Hodgkin lymphoma and CAR-T outcomes is limited, Herr said. However, a prior paper showed patients who could not complete a 6-mintue walk test had adverse short-term outcomes.
“We previously implemented an ICANS screening tool after CAR-T therapy using physical function measures to help identify ICANS,” Herr said. “If we can use this tool after CAR-T to identify ICANS, we thought we might be able to use these functions prior to CAR-T to predict ICANS.”
Herr and colleagues evaluated data from 91 patients (56% aged older than 60 years; 67% men; 89% non-Hispanic white) with non-Hodgkin lymphoma who underwent CAR T-cell therapy between 2018 and 2023. More than half (56%) had CAR-HEMATOTOX scores of 2 or higher.
A higher percentage of patients received axicabtagene ciloleucel (Yescarta, Kite Pharma; 62%) than tisagenlecleucel (Kymriah, Novartis; 38%).
Median follow-up was 2.9 years.
Forty-one patients (45%) achieved complete response and 18% developed high-grade ICANS.
Multivariable analysis showed patients who reported a fall in the prior 6 months had a five-fold greater risk for ICANs than those who did not fall during that period (P =.02).
Those unable to balance on their left leg for at least 10 seconds had a 2.6-fold higher likelihood of developing ICANS than those able to do so (P =.04).
Investigators identified several factors were associated with significantly higher risk for 1-year mortality, including use of an assistive device (HR = 2.6), strength deficits (HR = 2.3) and positive Romberg test (HR = 3.1), a neurologic assessment of coordination and balance.
Results showed a statistically significant association between CAR-HEMATOTOX score and 1-year mortality (HR =5).
Multivariable analysis of patients with high CAR-HEMATOX scores showed a significantly lower 1-year OS rate among those with two or more adverse physical functions than those with no adverse physical functions (9% vs. 65%).
“These physical function measures are fast, easy and inexpensive ways to identify patients who will have favorable [or] unfavorable outcomes with CAR-T,” Herr told Healio. “They have the potential to provide critically important insights to inform treatment decisions and post-treatment care for our patients.”
References:
- Herr M, et al. Abstract 58. Presented at: Tandem Meetings | Transplantation & Cellular Therapy Meetings of ASTCT and CIBMTR; Feb 12-15, 2025; Honolulu.
- Herr MM, et al. Biol Blood Marrow Transplant. 2020;doi:10.1016/j.bbmt.2020.07.031.
For more information:
Megan Herr, PhD, can be reached at megan.herr@roswellpark.org.
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