CR4 RESOURCE UTILIZATION WITHIN 30 DAYS OF CAR T CELLS FOR HEMATOLOGIC MALIGNANCIES

Abstract

To characterize institutional resources for 30 days after chimeric antigen receptor-modified (CAR) T cells administration. Adult patients treated on selected investigator-initiated clinical trials of CAR T cell therapy at Memorial Sloan Kettering Cancer Center were identified from the institutional database. Utilization data was collected from day -7 through day 30 from CAR T cell infusion. Descriptive statistics were used to analyze the data. Patients with B-cell acute lymphoblastic leukemia (ALL, 56, 53%), chronic lymphocytic leukemia (CLL, 37, 35%), and multiple myeloma (MM, 13, 12%) received CAR T cells from 6/2007 to 4/2018 on 4 clinical trials. The median age was 53 yrs (range 22-77) with 35% female. The median length of stay for the admission during which CAR T cells was given was 23 days (range 4 -38), with 41% in the intensive care unit (ICU) for at least 1 day, with a range of 1-28 days. A total of 40,327 laboratory panels and 955 radiology studies occurred. Seventeen percent of the labs were complete blood counts, basic or comprehensive metabolic panels, or liver function tests. Among the radiology studies, 25% were CT scans, 10% MRIs, 4% PET scans, 6% ultrasounds, and 56% x-rays, with differences in patterns of use by disease type. 20,367 medications were given with 102/106 pts receiving chemotherapy. All patients received some antibiotics. 25 doses of tocilizumab were given to 20 patients (19%), with 25% of ALL pts receiving a dose. Pressors were given to 20% of patients and growth factors to 57%. Identifying the resources needed for CAR T cell therapy will allow for better resource allocation. Improvement and standardization CAR T cell-related toxicity management may permit safer delivery of this therapy and reduce costs per patient. Comparison with alternative resource intense therapies is warranted.