1. The use of ICU resources in CAR-T cell recipients: a hospital-wide study.
- Author
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Valade, Sandrine, Darmon, Michael, Zafrani, Lara, Mariotte, Eric, Lemiale, Virginie, Bredin, Swann, Dumas, Guillaume, Boissel, Nicolas, Rabian, Florence, Baruchel, André, Madelaine, Isabelle, Larghero, Jérôme, Brignier, Anne, Lengliné, Etienne, Harel, Stéphanie, Arnulf, Bertrand, Di Blasi, Roberta, Thieblemont, Catherine, and Azoulay, Elie
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CYTOKINE release syndrome , *B cell lymphoma , *CHIMERIC antigen receptors , *CATHETER-related infections , *MULTIPLE myeloma , *DIFFUSE large B-cell lymphomas - Abstract
Background: CAR-T cell (chimeric antigen receptor T) therapy has emerged as an effective treatment of refractory hematological malignancies. Intensive care management is intrinsic to CAR-T cell therapy. We aim to describe and to assess outcomes in critically ill CAR-T cell recipients. Study design and methods: Hospital-wide retrospective study. Consecutive CAR-T cell recipients requiring ICU admission from July 2017 and December 2020 were included. Results: 71 patients (median age 60 years [37–68]) were admitted to the ICU 6 days [4–7] after CAR-T cell infusion. Underlying malignancies included diffuse large B cell lymphoma (n = 53, 75%), acute lymphoblastic leukemia (17 patients, 24%) and multiple myeloma (n = 1, 1.45%). Performance status (PS) was 1 [1–2]. Shock was the main reason for ICU admission (n = 40, 48%). Isolated cytokine release syndrome (CRS) was the most common complication (n = 33, 46%), while 21 patients (30%) had microbiologically documented bacterial infection (chiefly catheter-related infection). Immune effector cell-associated neurotoxicity syndrome was reported in 26 (37%) patients. At ICU admission, vasopressors were required in 18 patients (25%) and invasive mechanical ventilation in two. Overall, 49 (69%) and 40 patients (56%) received tocilizumab or steroids, respectively. Determinant of mortality were the reason for ICU admission (disease progression vs. sepsis or CRS (HR 4.02 [95%CI 1.10–14.65]), Performance status (HR 1.97/point [95%CI 1.14–3.41]) and SOFA score (HR 1.16/point [95%CI 1.01–1.33]). Conclusions: Meaningful survival could be achieved in up to half the CAR-T cell recipients. The severity of organ dysfunction is a major determinant of death, especially in patients with altered performance status or disease progression. [ABSTRACT FROM AUTHOR]
- Published
- 2022
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