Risk stratification for immune effector cell-associated neurotoxicity syndrome in patients receiving chimeric antigen receptor T cell therapy.

Abstract

e14534 Background: Chimeric Antigen Receptor-T (CAR-T) cell therapy is a novel immunotherapy that has successfully been used to treat hematological cancers. However, CAR-T cell therapy has significant neurotoxic adverse effects including immune effector cell-associated neurotoxicity syndrome (ICANS). There is limited data that stratifies patients undergoing CAR-T cell therapy that are at increased risk of ICANS. We therefore investigated characteristics among patients receiving CAR-T cell therapy associated with increased risk of ICANS. Methods: We used ICD-10 codes to query the National Inpatient Sample database from the year 2016 to 2020 to identify patients receiving CAR-T cell therapy, aged 18 years and older. We used logistic regression models with random-effects to adjust for age, gender, race and chronic comorbidities at individual-level and clustering at hospital-level and obtained adjusted odds ratios (aORs) and 95% confidence intervals of factors associated with ICANS among patients receiving CAR-T cell therapy. Results: Of 467 patients receiving CAR-T cell therapy included (median age in years [interquartile range], 60 [54 -70]; 40.0% female; 75.6% White, 7.3% Black, 8.4% Hispanic), 29 (6.2%) had ICANS. Having acute kidney injury (AKI) [aOR = 4.2, 95%CI: 1.6–10.1] or sepsis [aOR = 6.1, 95%CI: 1.9 - 19.4] were significantly associated with ICANS compared to those without these risk factors. Conclusions: In patients receiving CAR-T cell therapy, having AKI or sepsis was found to be associated with an increased risk of ICANS. These findings suggest that identifying patients who have AKI or sepsis preceding or during CAR-T cell therapy infusions may help predict which patients are at increased risk of ICANS.