Emerging Trends in Chimeric Antigen Receptor T-Cell Immunotherapy in Adults from the Vizient Clinical Database

Abstract

Introduction Chimeric Antigen Receptor T-cell (CAR-T) Immunotherapy was approved by the FDA in 2017 for certain pediatric and young adult patients with a form of acute lymphoblastic leukemia (ALL), as well as adult patients with relapsed or refractory large B-cell lymphoma after two or more lines of systemic therapy. CAR-T immunotherapy uses a patient's own T cells and modifies them in a laboratory to recognize and kill the patient's cancer. Since the CAR-T modified cells multiply and persist in the patient's bloodstream, they have the potential to protect the patient against recurrence. Beginning October 1, 2017, two new, unique ICD-10 procedure codes were assigned to CAR-T immunotherapy (XW033C3 for peripheral venous route and XW043C3 for central venous route), allowing for tracking of the procedure in administrative datasets. Objectives To describe trends in adult patient populations, outcomes, and adverse events using the CAR-T procedure codes in administrative data. Methods A retrospective cohort of 735 patients 18 years and older undergoing CAR-T procedures was identified from the Vizient Clinical Data Base / Resource Manager from 45 hospitals between October 2017 and August 2018. Results The 735 patients were largely white (77.3%), male (63.7%), commercial (55.0%) patients with large B-cell lymphoma (61.5%). Other cancer types included other B-cell lymphoma (19.3%), multiple myeloma (4.2%), follicular lymphoma (3.9%), and ALL (1.9%). The median length of stay was 15 days, the median total cost of hospitalization for CAR-T encounter was $82,059 and median direct cost was $43,108. During the initial hospitalization, 508 (69.1%) of patients had an adverse event due to the immunotherapy and 91 (12.4%) were coded for other complications following infusion, transfusion or therapeutic injection. 417 patients (56.7%) had fever, 403 (54.8%) had a change in blood pressure, 189 (25.7%) had nausea, 137 (18.6%) had a headache or migraine, 110 (15.0%) had acute kidney failure and 30 patients (1.5%) had an in-hospital death. Within 30 days, 117 patients (15.9%) had an unplanned readmission to the index hospital, with 69 (5.9%) patients being readmitted within 7 days of discharge. Conclusion Due to the recent implementation of the unique ICD-10 codes, more time and follow-up for these adult patients is needed to determine outcomes after receiving CAR-T immunotherapy, especially to track significant adverse events, including potentially cytokine release syndrome, neurologic complications and kidney/liver failure.