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- Title
The use of ICU resources in CAR-T cell recipients: a hospital-wide study.
- Authors
Valade, Sandrine; Darmon, Michael; Zafrani, Lara; Mariotte, Eric; Lemiale, Virginie; Bredin, Swann; Dumas, Guillaume; Boissel, Nicolas; Rabian, Florence; Baruchel, André; Madelaine, Isabelle; Larghero, Jérôme; Brignier, Anne; Lengliné, Etienne; Harel, Stéphanie; Arnulf, Bertrand; Di Blasi, Roberta; Thieblemont, Catherine; Azoulay, Elie
- Abstract
Background: CAR-T cell (chimeric antigen receptor T) therapy has emerged as an effective treatment of refractory hematological malignancies. Intensive care management is intrinsic to CAR-T cell therapy. We aim to describe and to assess outcomes in critically ill CAR-T cell recipients. Study design and methods: Hospital-wide retrospective study. Consecutive CAR-T cell recipients requiring ICU admission from July 2017 and December 2020 were included. Results: 71 patients (median age 60 years [37–68]) were admitted to the ICU 6 days [4–7] after CAR-T cell infusion. Underlying malignancies included diffuse large B cell lymphoma (n = 53, 75%), acute lymphoblastic leukemia (17 patients, 24%) and multiple myeloma (n = 1, 1.45%). Performance status (PS) was 1 [1–2]. Shock was the main reason for ICU admission (n = 40, 48%). Isolated cytokine release syndrome (CRS) was the most common complication (n = 33, 46%), while 21 patients (30%) had microbiologically documented bacterial infection (chiefly catheter-related infection). Immune effector cell-associated neurotoxicity syndrome was reported in 26 (37%) patients. At ICU admission, vasopressors were required in 18 patients (25%) and invasive mechanical ventilation in two. Overall, 49 (69%) and 40 patients (56%) received tocilizumab or steroids, respectively. Determinant of mortality were the reason for ICU admission (disease progression vs. sepsis or CRS (HR 4.02 [95%CI 1.10–14.65]), Performance status (HR 1.97/point [95%CI 1.14–3.41]) and SOFA score (HR 1.16/point [95%CI 1.01–1.33]). Conclusions: Meaningful survival could be achieved in up to half the CAR-T cell recipients. The severity of organ dysfunction is a major determinant of death, especially in patients with altered performance status or disease progression.
- Subjects
CYTOKINE release syndrome; B cell lymphoma; CHIMERIC antigen receptors; CATHETER-related infections; MULTIPLE myeloma; DIFFUSE large B-cell lymphomas
- Publication
Annals of Intensive Care, 2022, Vol 12, Issue 1, p1
- ISSN
2110-5820
- Publication type
Article
- DOI
10.1186/s13613-022-01036-2