Emergency Department Utilization for Patients Receiving Chimeric Antigen Receptor T Cell Infusion Therapy.

Chimeric antigen receptor T cell infusion (CAR T) therapy revolutionized and led to a paradigm shift in the treatment of hematologic malignancies, but treatment- related toxicities including cytokine release syndrome and immune effector cell- associated neurotoxicity syndrome are of concern. In this study, we aimed to understand the timing and reasons for which patients present to the emergency department (ED) after CAR T therapy to better assist with early recognition and management of these toxicities. We conducted a retrospective observational study for patients who had undergone CAR T therapy in the past 6 months and visited the ED of our comprehensive cancer center between 04/01/2018 and 08/01/2022. We examined the timing of presentation after CAR T product infusion, patient characteristics, and outcomes of the ED visit. Survival analyses were conducted using Cox proportional hazards regression and Kaplan-Meier estimates. During the period studied, there were 276 ED visits by 168 unique patients. Most patients had diffuse large B-cell lymphoma (103/168; 61.3%), multiple myeloma (21/168; 12.5%), or mantle cell lymphoma (16/168; 9.5%). Almost all 276 visits required urgent (60.5%) or emergent (37.7%) care and 73.5% of visits led to admission to the hospital or observation unit. Fever was the most frequent presenting complaint, reported in 19.6% of the visits. The 30-day and 90-day mortality rates after the index ED visits were 17.0% and 32.2% respectively. Patients who had their first ED visit >14 days after CAR T product infusion had significantly worse overall survival (multivariable hazard ratio 3.27; 95% confidence interval 1.29–8.27; P=0.012) than patients who first visited the ED within 14 days of CAR T product infusion. Cancer patients who receive CAR T therapy frequently visit the ED and most are admitted and/or require urgent or emergent care. Early ED visits may indicate early systemic inflammatory response to CAR T therapy, with patients mainly presenting with constitutional symptoms such as fever and fatigue, and these early visits are associated with better overall survival. [ABSTRACT FROM AUTHOR]