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Outcomes in patients treated with chimeric antigen receptor T-cell therapy who were admitted to intensive care (CARTTAS): an international, multicentre, observational cohort study
- Source :
- The Lancet Haematology, The Lancet Haematology, 2021, 8 (5), pp.e355-e364. ⟨10.1016/S2352-3026(21)00060-0⟩, The Lancet Haematology, Elsevier, 2021, 8 (5), pp.e355-e364. ⟨10.1016/S2352-3026(21)00060-0⟩, Lancet Haematology, 8, E355-E364, Dipòsit Digital de la UB, Universidad de Barcelona, Lancet Haematology, 8, 5, pp. E355-E364
- Publication Year :
- 2021
-
Abstract
- Summary Background Chimeric antigen receptor (CAR) T-cell therapy can induce side-effects such as cytokine release syndrome and immune effector cell-associated neurotoxicity syndrome (ICANS), which often require intensive care unit admission. The aim of this study was to describe management of critically ill CAR T-cell recipients in intensive care. Methods This international, multicentre, observational cohort study was done in 21 intensive care units in France, Spain, the USA, the UK, Russia, Canada, Germany, and Austria. Eligible patients were aged 18 years or older; had received CAR T-cell therapy in the past 30 days; and had been admitted to intensive care for any reason. Investigators retrospectively included patients admitted between Feb 1, 2018, and Feb 1, 2019, and prospectively included patients admitted between March 1, 2019, and Feb 1, 2020. Demographic, clinical, laboratory, treatment, and outcome data were extracted from medical records. The primary endpoint was 90-day mortality. Factors associated with mortality were identified using a Cox proportional hazard model. Findings 942 patients received CAR T-cell therapy, of whom 258 (27%) required admission to intensive care and 241 (26%) were included in the analysis. Admission to intensive care was needed within median 4·5 days (IQR 2·0–7·0) of CAR T-cell infusion. 90-day mortality was 22·4% (95% CI 17·1–27·7; 54 deaths). At initial evaluation on admission, isolated cytokine release syndrome was identified in 101 patients (42%), cytokine release syndrome and ICANS in 93 (39%), and isolated ICANS in seven (3%) patients. Grade 3–4 cytokine release syndrome within 1 day of admission to intensive care was found in 50 (25%) of 200 patients and grade 3–4 ICANS in 38 (35%) of 108 patients. Bacterial infection developed in 30 (12%) patients. Life-saving treatments were used in 75 (31%) patients within 24 h of admission to intensive care, primarily vasoactive drugs in 65 (27%) patients. Factors independently associated with 90-day mortality by multivariable analysis were frailty (hazard ratio 2·51 [95% CI 1·37–4·57]), bacterial infection (2·12 [1·11–4·08]), and lifesaving therapy within 24 h of admission (1·80 [1·05–3·10]). Interpretation Critical care management is an integral part of CAR T-cell therapy and should be standardised. Studies to improve infection prevention and treatment in these high-risk patients are warranted. Funding Groupe de Recherche Respiratoire en Reanimation Onco-Hematologique.
- Subjects :
- Male
MESH: Neurotoxicity Syndromes
MESH: Registries
[SDV]Life Sciences [q-bio]
MESH: Multiple Myeloma
Immunotherapy, Adoptive
Severity of Illness Index
law.invention
MESH: Proportional Hazards Models
Medicina intensiva
Clinical trials
0302 clinical medicine
law
Clinical endpoint
Medicine
Infection control
Registries
MESH: Treatment Outcome
MESH: Middle Aged
Medical record
Hazard ratio
[SDV.MHEP.HEM]Life Sciences [q-bio]/Human health and pathology/Hematology
Hematology
MESH: Follow-Up Studies
Middle Aged
Precursor Cell Lymphoblastic Leukemia-Lymphoma
Intensive care unit
3. Good health
Survival Rate
Cytokine release syndrome
Intensive Care Units
Treatment Outcome
030220 oncology & carcinogenesis
MESH: Immunotherapy, Adoptive
Female
Neurotoxicity Syndromes
Lymphoma, Large B-Cell, Diffuse
Cytokine Release Syndrome
Multiple Myeloma
Care of the sick
Cohort study
Adult
medicine.medical_specialty
Critical Care
MESH: Survival Rate
Other Research Radboud Institute for Molecular Life Sciences [Radboudumc 0]
MESH: Cytokine Realease Syndrome
03 medical and health sciences
All institutes and research themes of the Radboud University Medical Center
MESH: Critical Care
Internal medicine
Intensive care
MESH: Severity of Illness Index
Humans
Cura dels malalts
Critical care medicine
Proportional Hazards Models
MESH: Precursor Cell Lymphoblastic Leukemia-Lymphoma
MESH: Humans
business.industry
MESH: Lymphomz, Large B-Cell, Diffuse
MESH: Adult
MESH: Intensive care Units
medicine.disease
MESH: Male
business
MESH: Female
Assaigs clínics
030215 immunology
Follow-Up Studies
Subjects
Details
- ISSN :
- 23523026
- Volume :
- 8
- Database :
- OpenAIRE
- Journal :
- Lancet Haematology
- Accession number :
- edsair.doi.dedup.....10e0221bac10970ab09383fbb48e5504