Longitudinal patient-reported outcomes in patients receiving chimeric antigen receptor T-cell therapy.

Abstract

Chimeric antigen receptor T-cell therapy (CAR-T) has transformed the treatment for relapsed/refractory hematologic malignancies; however, data on patient-reported outcomes in CAR-T are limited. We conducted a longitudinal study of adults with hematologic malignancies receiving CAR-T. We assessed quality of life (QOL; functional assessment of cancer therapy-general), psychological distress (hospital anxiety and depression scale, patient health questionnaire-9, posttraumatic stress disorder [PTSD] checklist), and physical symptoms (Edmonton symptom assessment scale-revised) at baseline, 1week, 1, 3, and 6months after CAR-T. We used linear mixed models to identify factors associated with QOL trajectory. We enrolled 103 of 142 eligible patients (3 did not receive CAR-T). QOL (B= 1.96; P< .001) and depression (B=-0.32; P= .001) worsened by 1week and improved by 6months after CAR-T. At 6months, 18%, 22%, and 22% reported clinically significant depression, anxiety, and PTSD symptoms, respectively. At 1week, 52% reported severe physical symptoms, declining to 28% at 6months after CAR-T. In unadjusted linear mixed models, worse Eastern Cooperative Oncology Group performance status (B= 1.24; P= .042), receipt of tocilizumab (B= 1.54; P= .042), and receipt of corticosteroids for cytokine release syndrome and/or neurotoxicity (B= 2.05; P= .006) were associated with higher QOL trajectory. After CAR-T, QOL declined, and depression increased early, followed by improvements in QOL, psychological distress, and physical symptoms by6months after infusion. A significant minority of patients reported substantial psychological distress and physical symptoms longitudinally.