ED Visits, Readmissions Common After CAR T Therapy

M. Alexander Otto, PA, MSS

May 11, 2022

Many patients face emergency department (ED) visits and hospital readmissions following chimeric antigen receptor (CAR) T-cell therapy, according to a new report in JAMA Oncology.

Researchers found that nearly 40% of patients were rehospitalized at least once within 12 months of treatment, and about 1 in 5 visited the ED at least once.

"Primary disease and infections in the context of myelosuppression emerged as leading reasons for increased health care use, particularly in the first month," lead author Kelly Kenzi, PhD, assistant professor at the Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, and colleagues write.

CAR T-cell therapy has "transformed" the treatment of relapsed and refractory hematologic malignancies, but patients can be at risk for significant toxicities.

To better understand these risks, Kenzik and colleagues examined rehospitalizations and ED visits following hospitalization for CAR T-cell infusion.

The researchers identified 211 commercially insured patients treated with either axicabtagene ciloleucel (Yescarta) or tisagenlecleucel (Kymriah) between 2017 and 2019. The researchers assessed whether these patients, after being discharged following CAR T-cell infusion, were subsequently documented to have been rehospitalized or to have had ED visits during a 12-month period or until additional chemotherapy, death (n = 6), loss of coverage, or December 31, 2019.

The patients' median age was 55 years. Median post-infusion follow-up was 6.5 months, and cancer diagnoses included B-cell lymphoma (68.3%), chronic lymphocytic leukemia (7.6%), or another cancer type (24.2%).

The researchers found that 83 of 211 patients (39.3%) were readmitted to the hospital following CAR T-cell infusion. Rehospitalizations occurred most often in the first month then dropped off rapidly thereafter. The most common reasons for hospital readmission included problems related to the patients' primary disease, often with myelosuppression, as well as treatment-related adverse events and infections.

In addition, 45 patients (21.3%) visited the ED following CAR T-cell infusion. The most common reasons for these visits included primary disease (42.2%), infection (20.3%), and pain (10.9%).

Just over 19% of patients had two or more rehospitalizations, and 6.2% had two or more ED visits over the study period, which suggests "intensive health care use among high-risk subgroups," the authors write.

Overall, the researchers conclude that their "findings could inform strategies to mitigate unplanned health care use after CAR T-cell infusion," but they acknowledge that more work is needed to identify "high-risk subpopulations experiencing repeated hospitalizations and ED visits."

The study was funded by the American Cancer Society. One investigator has received personal fees from AstraZeneca.

JAMA Oncol. Published online May 5, 2022. Abstract

M. Alexander Otto is a physician assistant with a master's degree in medical science. He is an award-winning medical journalist who worked for several major news outlets before joining Medscape and is an MIT Knight Science Journalism fellow. Email: aotto@mdedge.com.

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