Patients with hematologic malignancies may experience a significant improvement in their reported quality of life 6 months after receiving chimeric antigen receptor (CAR) T-cell therapy, according to a new study published by Johnson et al in Blood Advances.
Background
Although CAR T-cell therapy may have transformed cancer treatment, relatively few studies have investigated the impact of the therapy on longitudinal patient quality of life—an aspect of cancer care that often suffers from receiving traditional intensive cancer medications such as chemotherapy.
“CAR [T-cell therapy] has revolutionized the treatment of patients with relapsed and refractory [hematologic malignancies]. But it remains a unique treatment with unique toxicities—including cytokine-release syndrome, which is an inflammatory flu-like ailment, as well as neurologic toxicities. And these complications can take a toll on patients,” explained lead study author Patrick Connor Johnson, MD, an attending medical oncologist at Massachusetts General Hospital. “Given the relatively new development of CAR [T-cell] therapy, there are a limited set of studies that have examined patient-reported outcomes in those receiving these treatments,” he added.
Study Methods and Results
In the new study, investigators enrolled 103 patients aged 23 to 90 years who had a hematologic malignancy from April 2019 to November 2021. Among these patients, 71% of them had lymphoma, 28% had myeloma, and 1% had B-cell acute lymphoblastic leukemia. Physicians administered tisagenlecleucel to 34% of patients eligible to receive CAR T-cell therapy., lisocabtagene maraleucel to 16%, axicabtagene ciloleucel to 13%, and idecabtagene vicleucel to 12%.
The investigators asked the study participants to complete self-reported questionnaires measuring quality-of-life variables prior to the receipt of CAR T-cell therapy, as well as 1 week, 1 month, 3 months, and 6 months after receiving CAR T-cell therapy. They measured quality of life using the Functional Assessment of Cancer Therapy–General—a 27-item questionnaire that measures quality-of-life factors using four different subscales (physical, functional, emotional, and social) at all time points.
Additionally, the investigators calculated psychological distress using the Hospital Anxiety and Depression Scale, which assessed variables designed to measure anxiety and depression symptoms at all time points. They evaluated major depressive symptoms using the Patient Health Questionnaire–9, and posttraumatic stress disorder symptoms using the Post-Traumatic Stress Checklist. They also recorded physical symptoms using the Edmonton Symptom Assessment System to assess pain, fatigue, drowsiness, nausea, appetite, dyspnea, insomnia, difficulty swallowing, and well-being over 24 hours.
Overall, 76% of the patients achieved remission and 33% of them experienced the common CAR T-cell therapy side effect of immune effector cell–associated neurotoxicity syndrome. The investigators revealed that 38% of the patients did not survive the length of the follow-up.
The investigators found that for most individuals, quality of life initially declined from a median baseline of 77.9 to 70.1 in the first week after the administration of CAR T-cell therapy—a time when treatment-related symptoms typically peak—and then significantly increased to a median of 83.7 after 6 months following therapy. Similarly, they found improvements in physical symptom burden as well as anxiety symptoms.
Although most study participants ultimately experienced an improvement in their quality of life, roughly 20% of the patients experienced persistent physical and psychological symptoms that, at times, were detrimental to their quality of life.
Conclusions
Dr. Johnson said that the new findings illustrate the burden CAR T-cell therapy may bring to some patients to maximize the effectiveness of these therapies and improve cancer care for all patients living with hematologic malignancies.
“Here, we show significant improvements in quality of life among patients with an array of [hematologic malignancies] receiving a variety of CAR [T-cell] products,” emphasized Dr. Johnson. “However, we also identify a distinct subset of patients who have persistent physical and psychological symptom burdens, even at the 6-month post–CAR [T-cell therapy] time point. I hope that these findings lead to additional interventions with a goal of improving the overall quality of life trajectory of all patients,” he concluded.
Disclosure: For full disclosures of the study authors, visit ashpublications.org.
