|The following article features coverage from the American Society of Hematology 2020 meeting. Click here to read more of Cancer Therapy Advisor‘s conference coverage.|
The majority of patients who underwent chimeric antigen receptor (CAR) T-cell (CAR-T) therapy and needed intensive end-of-life (EOL) care, received that care — but palliative care and hospice referral were infrequently used to address the end-of-life needs of patients who had received CAR-T, according to data presented at the virtual 62nd American Society of Hematology (ASH) Annual Meeting and Exposition.
“CAR T-cell therapy has changed the treatment landscape of multiple hematologic malignancies,” said Patrick Connor Johnson, MD, of Massachusetts General Hospital, Boston.“CAR T-cell therapy, however, can be associated with significant and unique toxicities such as cytokine release syndrome, neurotoxicity, and persistent cytopenias.”
Patients who receive CAR-T are at risk for intensive health care utilization, and many patients may have disease progression, according to Dr Johnson. Despite this, there is a lack of data about health care utilization and EOL outcomes in this population.
Dr Johnson presented results of a retrospective study of 236 patients who had received CAR-T therapy at 2 academic centers from 2016 to 2019. Health care utilization information was extracted from the electronic health record on hospitalizations and receipt of care in the intensive care unit (ICU).
The median age of included patients was 62.5 years. The most common diagnosis was diffuse large B-cell lymphoma (45.3%). The most common CAR-T therapy used was axicabtagene ciloleucel (81.3%).
The median length of stay for CAR-T infusion was 15 days. Approximately 12% of patients required ICU admission during CAR-T infusion and 15.5% required ICU admission within 3 months.
Among the 84 patients who died, 58.3% were hospitalized in the last 30 days of life, and about one-third (32.5%) received chemotherapy in the last 30 days of life. More than one-third of patients died in a hospital, rehabilitation facility, or nursing home.
Receipt of bridging therapy, length of stay longer than 14 days, hospital admission within 3 months of CAR-T infusion, and indolent lymphoma transformed to DLBCL were all significantly associated with hospitalization in the last 30 days of life. Complete response to CAR-T was associated with a lower likelihood of hospitalization in the last 30 days of life.
Fewer than half of patients (47.6%) had palliative care consultation; only 30.9% of patients were referred to hospice. Of those who were referred to hospice, more than 75% had a hospice stay of less than 7 days.
Palliative care consult was the only factor significantly associated with hospice referral (odds ratio [OR], 3.18; P =.044).
“Care transitions and symptom monitoring interventions may be particularly useful targets for future research aimed at mitigating health care utilization in this unique population,” Dr Johnson concluded.
Disclosures: Some of the presenters disclosed financial relationships with the pharmaceutical industry and/or the medical device industry. For a full list of disclosures, please refer to the presentation abstract.
Read more of Cancer Therapy Advisor‘s coverage of the ASH 2020 meeting by visiting the conference page.
Johnson PC, Frigault MJ, Yi A, et al. Health care utilization and end of life (EOL) outcomes in patients receiving CAR T-cell therapy. Presented at 62nd American Society of Hematology (ASH) Annual Meeting and Exposition. December 5-8, 2020. Abstract 311.