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. 2022 Aug 17;12(1):75.
doi: 10.1186/s13613-022-01036-2.

The use of ICU resources in CAR-T cell recipients: a hospital-wide study

Sandrine Valade  1   2 , Michael Darmon  3   4 , Lara Zafrani  3   4 , Eric Mariotte  3   4 , Virginie Lemiale  3   4 , Swann Bredin  3   4 , Guillaume Dumas  3   4 , Nicolas Boissel  4   5 , Florence Rabian  4   5 , André Baruchel  6 , Isabelle Madelaine  7 , Jérôme Larghero  8   9 , Anne Brignier  10 , Etienne Lengliné  11 , Stéphanie Harel  4   12 , Bertrand Arnulf  4   12 , Roberta Di Blasi  4   13 , Catherine Thieblemont  4   13 , Elie Azoulay  3   4
Affiliations

The use of ICU resources in CAR-T cell recipients: a hospital-wide study

Sandrine Valade et al. Ann Intensive Care. .

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.

Keywords: Anti-CD19 chimeric antigen receptor; Hematological malignancies; Intensive care; Performance status; Sepsis.

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Conflict of interest statement

SV reports non-financial support from Pfizer, personal fees from Gilead-Kite, personal, personal fees from Sanofi, outside the submitted work. AB reports non-financial support from Gilead, personal fees from BMS-Celgene, personal, personal fees from Janssen outside the submitted work. JL reports non-financial support from Gilead, personal fees from Novartis, Gilead and BMS, outside the submitted work. CT reports non-financial support from BMS-Celgene, Janssen, Gilead, personal fees from Gilead, Kite, Takeda, Novartis, BMS-Celgene, Astrazeneca, Janssen, Sanofiu and Roche, outside the submitted work. EM reports personal fees from Sanofi, outside the submitted work. EA reports personal fees from Gilead, personal fees from Pfizer, personal fees from Baxter, personal fees from Alexion, outside the submitted work. MD reports grants from MSD, personal fees from Astelas, personal fees and non-financial support from Gilead-Kite, personal fees from Sanofi, outside the submitted work. LZ reports grants from Jazz Pharmaceuticals, outside the submitted work. Other authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Characteristics of patients according to the reason for ICU admission. CRS cytokine release syndrome
Fig. 2
Fig. 2
Overall survival (A) and progression-free survival (B) according to performance status (PS)
Fig. 3
Fig. 3
Overall survival (A) and progression-free survival (B) according to the reason for ICU admission
See this image and copyright information in PMC

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