Critically ill patients treated for chimeric antigen receptor-related toxicity: A multicenter study Journal Article
| Authors: | Gutierrez, C.; Brown, A. R. T.; May, H. P.; Beitinjaneh, A.; Stephens, R. S.; Rajendram, P.; Nates, J. L.; Pastores, S. M.; Dharshan, A.; de Moraes, A. G.; Hensley, M. K.; Feng, L.; Brudno, J. N.; Athale, J.; Ghosh, M.; Kochenderfer, J. N.; Arias, A. S.; Lin, Y.; McEvoy, C.; Mead, E.; Westin, J.; Kostelecky, N.; Mian, A.; Herr, M. M. |
| Article Title: | Critically ill patients treated for chimeric antigen receptor-related toxicity: A multicenter study |
| Abstract: | OBJECTIVES: To report the epidemiology, treatments, and outcomes of adult patients admitted to the ICU after cytokine release syndrome or immune effector cell-associated neurotoxicity syndrome. DESIGN: Retrospective cohort study SETTING: Nine centers across the U.S. part of the chimeric antigen receptor-ICU initiative. PATIENTS: Adult patients treated with chimeric antigen receptor T-cell therapy who required ICU admission between November 2017 and May 2019. INTERVENTIONS: Demographics, toxicities, specific interventions, and outcomes were collected. RESULTS: One-hundred five patients treated with axicabtagene ciloleucel required ICU admission for cytokine release syndrome or immune effector cell-associated neurotoxicity syndrome during the study period. At the time of ICU admission, the majority of patients had grade 3-4 toxicities (66.7%); 15.2% had grade 3-4 cytokine release syndrome and 64% grade 3-4 immune effector cell-associated neurotoxicity syndrome. During ICU stay, cytokine release syndrome was observed in 77.1% patients and immune effector cell-associated neurotoxicity syndrome in 84.8% of patients; 61.9% patients experienced both toxicities. Seventy-nine percent of patients developed greater than or equal to grade 3 toxicities during ICU stay, however, need for vasopressors (18.1%), mechanical ventilation (10.5%), and dialysis (2.9%) was uncommon. Immune Effector Cell-Associated Encephalopathy score less than 3 (69.7%), seizures (20.2%), status epilepticus (5.7%), motor deficits (12.4%), and cerebral edema (7.9%) were more prevalent. ICU mortality was 8.6%, with only three deaths related to cytokine release syndrome or immune effector cell-associated neurotoxicity syndrome. Median overall survival time was 10.4 months (95% CI, 6.64-not available mo). Toxicity grade or organ support had no impact on overall survival; higher cumulative corticosteroid doses were associated to decreased overall and progression-free survival. CONCLUSIONS: This is the first study to describe a multicenter cohort of patients requiring ICU admission with cytokine release syndrome or immune effector cell-associated neurotoxicity syndrome after chimeric antigen receptor T-cell therapy. Despite severe toxicities, organ support and in-hospital mortality were low in this patient population. |
| Keywords: | intensive care unit; management; outcomes; t-cell therapy; immune; cytokine release syndrome; admission; chimeric antigen receptor t-cell; effector cell-associated neurotoxicity syndrome |
| Journal Title: | Critical Care Medicine |
| Volume: | 50 |
| Issue: | 1 |
| ISSN: | 0090-3493 |
| Publisher: | Lippincott Williams & Wilkins |
| Date Published: | 2022-01-01 |
| Start Page: | 81 |
| End Page: | 92 |
| Language: | English |
| ACCESSION: | WOS:000730780000016 |
| DOI: | 10.1097/ccm.0000000000005149 |
| PROVIDER: | wos |
| PMCID: | PMC8678137 |
| PUBMED: | 34259446 |
| Notes: | Article -- Source: Wos |
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