Roedl Kevin, Ahmadi Paymon, Essmann Sonja, Aamir Sarosh, Haar Markus, Ayuk Francis, Karagiannis Panagiotis, Kröger Nicolaus, Kluge Stefan, Wichmann Dominic
Department of Intensive Care Medicine, University Medical Centre Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
Department of Stem Cell Transplantation, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.
Med Klin Intensivmed Notfmed. 2024 Dec 30. doi: 10.1007/s00063-024-01230-z.
CAR-T cell (chimeric antigen receptor T) therapy is now part of standard of care treatment of B‑cell lineage malignancies. Although it is an effective treatment, it comes along with adverse side effects and toxicities that may require intensive care therapy. The costs related to critical care therapy in critically ill patients after CAR‑T administration have not been evaluated.
Retrospective analysis of all patients who had received CAR‑T therapy and were admitted to the intensive care unit (ICU) of a tertiary care university medical centre in Germany between 1 January 2019 and 31 December 2022. Cause of admission and ICU therapy as well as treatment and total hospitals costs were evaluated.
Thirty patients with a history of CAR-T cell therapy for underlying haematological malignancy were included. The median age of all patients was 60 years (interquartile range [IQR] 50-70) and 37% (n = 11) were female. 93% (n = 28) of patients had non-Hodgkin lymphoma and 7% (n = 2) had multiple myeloma. The cohort was stratified whether the ICU admission was CAR‑T therapy related (i.e. within 30 days after CAR‑T therapy; 73%, n = 22) or the admission was of an other cause (> 30 days after CAR‑T therapy) (27%, n = 8). The median duration from CAR‑T therapy to ICU admission was 6 (range 5-8) days in CAR-T cell therapy associated ICU admissions compared with 52 (range 31-126) days in other admissions. The overall illness severity on admission was numerically higher in CAR-T-related ICU admission compared to other admissions (46 vs. 43 points, p = 0.18). Vasopressor therapy (50% vs. 75%; p = 0.19), invasive mechanical ventilation (27% vs. 50%; p = 0.24) and renal replacement therapy (14% vs. 50%; p < 0.05) were used in CAR-T-associated admission compared to other admissions, respectively. The ICU mortality (23% vs. 50%; p = 0.15) was higher in patients with other ICU admission. Median total costs of the entire inpatient stay in hospital were € 27,845 (range 8661-368,286 €) in CAR-T-associated ICU admissions compared to € 59,234 (range 23,182-127,044 €) in the group of other ICU admissions (costs of the CAR‑T product not included).
In relation to the total costs of CAR-T-cell therapy (production of the CAR‑T product), therapy-associated complications have a relatively low impact on the costs and utilization of ICU resources.
嵌合抗原受体T细胞（CAR-T）疗法现已成为B细胞系恶性肿瘤标准治疗方案的一部分。尽管它是一种有效的治疗方法，但会伴随不良副作用和毒性反应，可能需要重症监护治疗。CAR-T治疗后重症患者的重症监护治疗相关费用尚未得到评估。
对2019年1月1日至2022年12月31日期间在德国一家三级大学医学中心重症监护病房（ICU）接受CAR-T治疗的所有患者进行回顾性分析。评估入院原因、ICU治疗情况以及治疗和医院总费用。
纳入30例有CAR-T细胞治疗基础血液系统恶性肿瘤病史的患者。所有患者的中位年龄为60岁（四分位间距[IQR]50 - 70），37%（n = 11）为女性。93%（n = 28）的患者患有非霍奇金淋巴瘤，7%（n = 2）患有多发性骨髓瘤。根据ICU入院是否与CAR-T治疗相关（即CAR-T治疗后30天内；73%，n = 22）或入院由其他原因引起（CAR-T治疗后>30天）（27%，n = 8）对队列进行分层。与CAR-T细胞治疗相关的ICU入院中，从CAR-T治疗到ICU入院的中位时间为6（范围5 - 8）天，而其他入院情况为52（范围31 - 126）天。与其他入院相比，CAR-T相关ICU入院时的总体疾病严重程度在数值上更高（46分对43分，p = 0.18）。与其他入院相比，CAR-T相关入院分别使用血管活性药物治疗（50%对75%；p = 0.19）、有创机械通气（27%对50%；p = 0.24）和肾脏替代治疗（14%对50%；p < 0.05）。其他ICU入院患者的ICU死亡率更高（23%对50%；p = 0.15）。CAR-T相关ICU入院患者整个住院期间的中位总费用为27,845欧元（范围8661 - 368,286欧元），而其他ICU入院组为59,234欧元（范围23,182 - 127,044欧元）（未包括CAR-T产品的费用）。
相对于CAR-T细胞治疗的总成本（CAR-T产品的生产成本），治疗相关并发症对ICU资源的成本和利用影响相对较低。
