1Department of Medicine, Division of Hematology & Oncology, Massachusetts General Hospital Cancer Center & Harvard Medical School.
2Department of Medical Oncology, Center for Lymphoma, Dana-Farber Cancer Institute & Harvard Medical School; and.
J Natl Compr Canc Netw. 2021 Mar 11;19(8):928-934. doi: 10.6004/jnccn.2020.7678.
CAR T-cell therapy has revolutionized the treatment of patients with hematologic malignancies, but it can result in prolonged hospitalizations and serious toxicities. However, data on the impact of CAR T-cell therapy on healthcare utilization and end-of-life (EoL) outcomes are lacking.
We conducted a retrospective analysis of 236 patients who received CAR T-cell therapy at 2 tertiary care centers from February 2016 through December 2019. We abstracted healthcare utilization and EoL outcomes from the electronic health record, including hospitalizations, receipt of ICU care, hospitalization and receipt of systemic therapy in the last 30 days of life, palliative care, and hospice referrals.
Most patients (81.4%; n=192) received axicabtagene ciloleucel. Overall, 28.1% of patients experienced a hospital readmission and 15.5% required admission to the ICU within 3 months of CAR T-cell therapy. Among the deceased cohort, 58.3% (49/84) were hospitalized and 32.5% (26/80) received systemic therapy in the last 30 days of life. Rates of palliative care and hospice referrals were 47.6% and 30.9%, respectively. In multivariable logistic regression, receipt of bridging therapy (odds ratio [OR], 3.15; P=.041), index CAR-T hospitalization length of stay >14 days (OR, 4.76; P=.009), hospital admission within 3 months of CAR T-cell infusion (OR, 4.29; P=.013), and indolent lymphoma transformed to diffuse large B-cell lymphoma (OR, 9.83; P=.012) were associated with likelihood of hospitalization in the last 30 days of life.
A substantial minority of patients receiving CAR T-cell therapy experienced hospital readmission or ICU utilization in the first 3 months after CAR T-cell therapy, and most deceased recipients of CAR T-cell therapy received intensive EoL care. These findings underscore the need for interventions to optimize healthcare delivery and EoL care for this population.
嵌合抗原受体 T 细胞（CAR T）疗法彻底改变了血液系统恶性肿瘤患者的治疗方式，但它会导致住院时间延长和严重的毒性。然而，关于 CAR T 细胞疗法对医疗保健利用和生命终末期（EoL）结局影响的数据尚缺乏。
我们对 2016 年 2 月至 2019 年 12 月在 2 家三级护理中心接受 CAR T 细胞疗法的 236 例患者进行了回顾性分析。我们从电子病历中提取医疗保健利用和生命终末期结局数据，包括住院、入住重症监护病房（ICU）、CAR T 细胞治疗后 30 天内住院和接受全身治疗、姑息治疗和临终关怀转诊。
大多数患者（81.4%；n=192）接受了 axicabtagene ciloleucel 治疗。总体而言，28.1%的患者在 CAR T 细胞治疗后 3 个月内再次住院，15.5%需要入住 ICU。在死亡队列中，58.3%（49/84）住院，32.5%（26/80）在生命终末期的最后 30 天内接受全身治疗。姑息治疗和临终关怀转诊率分别为 47.6%和 30.9%。多变量逻辑回归分析显示，接受桥接治疗（比值比[OR]，3.15；P=.041）、指数 CAR-T 住院时间超过 14 天（OR，4.76；P=.009）、CAR T 细胞输注后 3 个月内住院（OR，4.29；P=.013）以及惰性淋巴瘤转化为弥漫性大 B 细胞淋巴瘤（OR，9.83；P=.012）与生命终末期住院的可能性相关。
相当一部分接受 CAR T 细胞疗法的患者在 CAR T 细胞疗法后 3 个月内再次住院或需要 ICU 治疗，大多数接受 CAR T 细胞疗法的死亡患者接受了强化生命终末期护理。这些发现强调需要采取干预措施，以优化该人群的医疗保健服务和生命终末期护理。
