In a single-institution study reported in a research letter in JAMA Oncology, Kenzik et al found substantial rates of rehospitalization and emergency department visits after chimeric antigen receptor (CAR) T-cell therapy among commercially insured patients with cancer.
Study Details
The study included 211 patients who received CAR T-cell infusion (axicabtagene ciloleucel, tisagenlecleucel) at age ≤ 65 years at the University of Alabama at Birmingham between 2017 and 2019. Patients were followed for rehospitalizations and emergency department visits after discharge from CAR T-cell infusion for 12 months or until additional chemotherapy, death (n = 6), loss of coverage, or end of December 2019.
Key Findings
Patients had a median age of 55 years (range = 1–64 years). Diagnoses consisted of B-cell lymphoma (68.3%), chronic lymphocytic leukemia (7.6%), pediatric leukemia (4.3%), and other (19.9%). Median postinfusion follow-up was 6.5 months (range ≤ 1–12 months).
A total of 83 patients (39.3%) had 145 rehospitalizations, with 42.2% of those with rehospitalization having two or more hospitalizations.
The 12-month cumulative incidence of cause-specific rehospitalization included primary disease, often with myelosuppression, or treatment-related adverse effects (26.1%), infection (19.7%), and other reasons (7.2%). The majority of rehospitalizations occurred within 30 days of discharge from infusion (0.23 per person-month), with the rate declining after 90 days after discharge from infusion (0.08 per person-month). On multivariate analysis for rehospitalization, no significant factors were identified.
A total of 45 patients (21.3%) had 64 emergency department visits after CAR T-cell infusion, with 28.8% of those with emergency departments visits having at least two visits. The median time to first emergency department visit was 84 days (range = 1–340 days) after discharge from infusion. The most common reasons for emergency department visits included primary disease (42.2%), infection (20.3%), and pain (10.9%).
The investigators concluded, “Among commercially insured CAR T-cell–treated patients in this cohort study, 39.3% were rehospitalized and 21.3% visited the emergency department during the 12 months after discharge from infusion. The most frequent reason for rehospitalization was primary disease (often with myelosuppression)….Rehospitalization rates were highest during the first month after infusion and declined rapidly thereafter.”
They further stated, “Our findings could inform strategies to mitigate unplanned health care use after CAR T-cell infusion. Primary disease and infections in the context of myelosuppression emerged as leading reasons for increased health care use, particularly in the first month. Future work identifying high-risk subpopulations experiencing repeated hospitalizations and emergency department visits is needed.”
Kelly M. Kenzik, PhD, of the University of Alabama at Birmingham, is the corresponding author for the JAMA Oncology article.
Disclosure: The study was supported by an American Cancer Society Mentored Research Scholar Grant in Applied and Clinical Research. For full disclosures of the study authors, visit jamanetwork.com.
