ICU UTILIZATION BY PATIENTS WHO RECEIVED TREATMENT WITH CAR-T CELLS

Abstract

SESSION TITLE: Wednesday Abstract Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/23/2019 09:45 AM - 10:45 AM PURPOSE: Chimeric antigen receptor T-cell therapy (CAR-T) is a type of immunotherapy currently used for patients with refractory hematologic malignancies. CAR-T therapy utilizes genetic modification of autologous T cells to recognize a specific tumor surface antigen. The most commonly recognized toxicities from CAR-T therapy are cytokine release syndrome (CRS) and neurotoxicity. CRS may present along a spectrum of fevers, tachycardia, or vasodilatory shock. Neurotoxic effects of CAR-T therapy also present with a variety of symptoms ranging from inattention to seizures. Due to these toxicities, some patients who receive CAR-T therapy may require an intensive care unit (ICU) level of care. There is a knowledge gap on presentation and management of this particular patient population. METHODS: There were 30 patients from January to December 2018 who received CAR-T therapy at this institution with axicabtagene ciloleucel. Of these patients, 12 (17.6%) experienced CRS and/or neurotoxicity requiring an ICU level of care. Data gathered from these patients included time to onset, peak and resolution of CRS and/or neurotoxicity, management, other adverse events and follow-up outcomes related to their malignancy. RESULTS: Of the 12 patients who required an ICU level of care for CRS and/or neurotoxicity, the median age was 52 with 83% males. The malignancies treated with CAR-T were high-grade non-Hodgkin lymphoma, transformed follicular lymphoma and diffuse large B-cell lymphoma. The average time to onset for CRS was 1.8 days (range 0-7 days) and for neurotoxicity was 5 days (range 3-8 days). Maximum CRS grade was 2, which was present in 83% of patients. 1 patient required vasopressor support and 1 patient experienced acute renal failure. All patients required close monitoring of neurologic status. 8 patients received treatment for CRS with tocilizumab and/or steroids. On average, CRS had a duration of 7.2 days (range 4-15 days). 58% of patients experienced hypogammaglobinemia. The average total ICU length of stay was 3 days (range 2-5 days). Presently, 7 patients have been evaluated for 6-month response to treatment. Of which, 2 patients have had a complete response. CONCLUSIONS: CRS and neurotoxicity are known complications of CAR-T therapy use in refractory hematologic malignancies. In some instances, patients may have neurologic compromise or vasodilatory shock requiring care in an ICU. This review of 12 cases summarizes features of features of these patients’ hospitalizations and demonstrates variable management strategies and outcomes. CLINICAL IMPLICATIONS: Utilization of CAR-T therapy is expected to expand in the coming years. Further research is indicated to optimize treatment of patients with CRS and neurotoxicity, predict timeline of potential events, and evaluate how CAR-T toxicities relate to both patient- and disease-centered outcomes. DISCLOSURES: No relevant relationships by Alice Gallo De Moraes, source=Web Response No relevant relationships by Paige Marty, source=Web Response