Emerging Trends in Chimeric Antigen Receptor T-Cell Immunotherapy in Young Adults and Pediatric Patients 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 young adult patient populations, outcomes, and hospitals using the CAR-T procedure codes in administrative data. Methods A retrospective cohort of 40 patients under 25 years undergoing CAR-T procedures was identified from the Vizient Clinical Data Base / Resource Manager from 20 hospitals between October 2017 and August 2018. Results For the 40 patients, 30 of the 40 had a diagnosis of ALL. Eight of the remaining 10 patients had diagnoses of large B-cell lymphoma, one patient had blastic NK-cell lymphoma, and one patient had acute myoblastic lymphoma. The median length of stay was 17 days, the median ICU stay was 0 days, the median total cost of hospitalization for CAR-T encounter was $280,276 and median direct cost was $152,633. During the initial hospitalization, 23 (57.5%) of patients had an adverse event due to the immunotherapy. 20 patients (50.0%) had fever, 9 (22.5%) had sepsis and 7 (17.5%) had acute kidney failure and 3 patients (7.5%) had an in-hospital death. Within 30 days, 6 patients (15.0%) had an unplanned readmission to the index hospital, 2 (0.5%) with sepsis and 2 (0.5%) with an adverse event due to the immunotherapy. Conclusion Due to the recent implementation of the unique ICD-10 codes, more time and follow-up for these young adult patients is needed to determine outcomes for pediatric cancer patients receiving CAR-T immunotherapy, especially to track significant adverse events, including potentially cytokine release syndrome, neurologic complications and kidney/liver failure.