ASH 2019: CAR T-Cell Therapy Shows Activity, Reduces Health-Care Utilization in Older Patients With DLBCL

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A new analysis of Medicare claims data presented by  Kilgore et al at the 2019 American Society of Hematology (ASH) Annual Meeting & Exposition (Abstract 793) has provided the first real-world evidence using claims data available after the approval of autologous anti-CD19 chimeric antigen receptor (CAR) T-cell therapy. These analyses showed that CAR T-cell therapy can be beneficial for a broad population of older patients with diffuse large B-cell lymphoma (DLBCL), including those with multiple chronic conditions. The research also showed patients spent less time in the hospital and had lower health-care costs after CAR T-cell therapy than they did in the months leading up to it.

The U.S. Food and Drug Administration (FDA) approved the first CAR T-cell therapy for adults with DLBCL in 2017. However, many of the patients included in the clinical trials leading up to that approval were middle-aged, with a median age of 56 to 58. This study used the earliest available Medicare claims data to assess the treatment’s use in Medicare patients aged 60 and older, who comprise the majority of Medicare beneficiaries and often have multiple chronic health issues.

“Our findings offer evidence that older patients with multiple comorbidities can be treated successfully with CAR T-[cell therapy],” said lead study author Karl M. Kilgore, PhD, of Avalere Health. “While we don’t know the long-term outcomes yet, nearly three-quarters of the patients were still alive 6 months posttreatment. Even in that narrow window of time, we saw a significant decline in health-care utilization, including hospitalizations and emergency room use, which is suggestive of a successful course of treatment.”

Analysis Details

The researchers analyzed claims data from patients enrolled in Medicare Fee for Service parts A and B from October 2017 to September 2018. They identified 207 patients with an average age of 70 years who had undergone CAR T-cell therapy for DLBCL. Half underwent CAR T-cell therapy as part of a clinical trial, while the remainder had comorbidities that likely would have excluded them from CAR T-cell therapy clinical trials.


Comparing health care utilization in the 6 months before and after CAR T-cell therapy, the researchers found patients’ average overall health-care costs dropped by 39% after undergoing CAR T-cell therapy, excluding the cost of the treatment itself. In the months following CAR T-cell therapy, patients spent less time in the hospital and had half as many emergency department visits than before the therapy. Only 7.2% had any evidence of subsequent chemotherapy in the claims data, suggesting that the cancer had not returned within the first 6 months following CAR T-cell therapy for most patients.

The researchers plan to compare the data to patients with private insurance and to a similar group of patients with DLBCL who did not receive CAR T-cell therapy to gain further insights into outcomes and costs.

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