Thirty Day Resource Utilization after Chimeric Antigen Receptor (CAR) T Cell Infusion for Hematologic Malignancies

Abstract

Background We aimed to characterize institutional resources utilized (other than T cell collection and CAR T cell manufacturing and infusion) peri-chimeric antigen receptor-modified (CAR) T cells administration. Methods Adult patients treated on selected investigator-initiated clinical trials of CAR T cell therapy at Memorial Sloan Kettering Cancer Center were identified from the institutional database. Utilization data was collected from the start of admission for CAR T cell infusion through the end of the initial admission for infusion or through 30 days following initial CAR T cell infusion, whichever was longer. Descriptive statistics were used to analyze the data. Results Between 6/2007 to 4/2018, 106 pts (56 pts (53%) B-cell acute lymphoblastic leukemia (ALL), 37 (35%) chronic lymphocytic leukemia (CLL), B-cell non-Hodgkin lymphoma (NHL), and 13 (12%) multiple myeloma (MM)) on 4 clinical trials receiving inpatient CAR T cell infusions. The median age was 53 yrs (range 22-77) with 65% male. The median length of stay for the admission during which CAR T cells was given was 23 days (range 4 -133), with ALL patients admitted longer (Figure 1). 43 (41%) spent at least one day in the intensive care unit (ICU), with a range of 0-43 days. Outpatient clinic visits through day 30 post CAR T cell infusion occurred in 57 (53%) patients. A total of 62,953 laboratory panels and 1,190 radiology studies done during the study time frame. Fourteen percent of the labs were complete blood counts, basic or comprehensive metabolic panels, or liver function tests. For the total population, ALL, CLL/NHL, MM, there were a median of 63.5 (range 13-368), 91.5 (21-368), 47 (13-167), and 51 (range 38-113) of these panels done per patient during the time frame, respectively. Among the radiology studies, 25% were CT scans, 10% MRIs, 7% PET scans, 5% ultrasounds, and 53% x-rays, with differences in patterns of use by disease type (Figure 2). Chemotherapy accounted for 328 units (0.8%) of the 41,331 units of medications given in this time frame. The median medication units per patient was 255 (range 35-2091), 423 (range 35-2091), 200 (range 41-1190), and 207 (range 90-666) for the total population, and the ALL, CLL/NHL, and MM pts, respectively. Thirty-two doses of tocilizumab were given to 25 patients (24%), with ALL pts receiving 23 of those doses (72%). Conclusion CAR T cell therapy utilizes many resources and can create challenges in institutional resource capacity. Identifying these resources will allow for better allocation and care delivery. Further refinement of CAR T cell products and improvements in CAR T cell-related toxicity management may permit safer delivery of this therapy and reduce costs per patient. Comparison with alternative therapies and analysis of resource utilization for the commercial CAR T cell products is warranted.