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. 2023 Jul 25;7(14):3541-3550.
doi: 10.1182/bloodadvances.2022009117.

Longitudinal patient-reported outcomes in patients receiving chimeric antigen receptor T-cell therapy

P Connor Johnson  1   2 , Tejaswini Dhawale  1   2 , Richard A Newcomb  1   2 , Hermioni L Amonoo  2   3   4 , Mitchell W Lavoie  5   6 , Dagny Vaughn  6   7 , Kyle Karpinski  6 , Areej El-Jawahri  1   2
Affiliations

Longitudinal patient-reported outcomes in patients receiving chimeric antigen receptor T-cell therapy

P Connor Johnson et al. Blood Adv. .

Abstract

Chimeric antigen receptor T-cell therapy (CAR-T) has transformed the treatment for relapsed/refractory hematologic malignancies; however, data on patient-reported outcomes in CAR-T are limited. We conducted a longitudinal study of adults with hematologic malignancies receiving CAR-T. We assessed quality of life (QOL; functional assessment of cancer therapy-general), psychological distress (hospital anxiety and depression scale, patient health questionnaire-9, posttraumatic stress disorder [PTSD] checklist), and physical symptoms (Edmonton symptom assessment scale-revised) at baseline, 1 week, 1, 3, and 6 months after CAR-T. We used linear mixed models to identify factors associated with QOL trajectory. We enrolled 103 of 142 eligible patients (3 did not receive CAR-T). QOL (B = 1.96; P < .001) and depression (B = -0.32; P = .001) worsened by 1 week and improved by 6 months after CAR-T. At 6 months, 18%, 22%, and 22% reported clinically significant depression, anxiety, and PTSD symptoms, respectively. At 1 week, 52% reported severe physical symptoms, declining to 28% at 6 months after CAR-T. In unadjusted linear mixed models, worse Eastern Cooperative Oncology Group performance status (B = 1.24; P = .042), receipt of tocilizumab (B = 1.54; P = .042), and receipt of corticosteroids for cytokine release syndrome and/or neurotoxicity (B = 2.05; P = .006) were associated with higher QOL trajectory. After CAR-T, QOL declined, and depression increased early, followed by improvements in QOL, psychological distress, and physical symptoms by 6 months after infusion. A significant minority of patients reported substantial psychological distress and physical symptoms longitudinally.

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Conflict of interest statement

Conflict-of-interest disclosure: P.C.J. provided consultation for AstraZeneca, Seagen, and ADC Therapeutics. The remaining authors declare no competing financial interests.

Figures

None
Graphical abstract
Figure 1.
Figure 1.
Longitudinal trajectory of PROs. (A) QOL; (B) depression symptoms (hospital anxiety and depression scale); (C) anxiety symptoms; (D) PTSD symptoms; and (E) depression symptoms (PHQ-9).
Figure 2.
Figure 2.
Rates of clinically significant psychological distress. The percentage of patients with clinically significant depression (hospital anxiety and depression scale), anxiety (hospital anxiety and depression scale), and PTSD (checklist) symptoms at each time point during CAR-T.
Figure 3.
Figure 3.
Longitudinal physical symptom burden. The percentage of patients with mild or no symptoms, moderate symptoms, or severe symptoms on the Edmonton symptom assessment scale–revised instrument at each time point during CAR-T.
See this image and copyright information in PMC

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