TY - JOUR
T1 - A multicenter study of ICU resource utilization in pediatric, adolescent and young adult patients post CAR-T therapy
AU - Ragoonanan, Dristhi
AU - Bhar, Saleh
AU - Mohan, Gopi
AU - Beltramo, Fernando
AU - Khazal, Sajad J.
AU - Hurley, Caitlin
AU - Andersen, Clark
AU - Margossian, Steven
AU - Neelapu, Sattva S.
AU - Shpall, Elizabeth
AU - Gutierrez, Cristina
AU - Tewari, Priti
AU - Shoberu, Basirat
AU - Talleur, Aimee
AU - McCall, David
AU - Nunez, Cesar
AU - Cuglievan, Branko
AU - Tambaro, Francesco Paolo
AU - Petropoulos, Demetrios
AU - Abdel-Azim, Hisham
AU - Mahadeo, Kris M.
N1 - Publisher Copyright:
Copyright © 2022 Ragoonanan, Bhar, Mohan, Beltramo, Khazal, Hurley, Andersen, Margossian, Neelapu, Shpall, Gutierrez, Tewari, Shoberu, Talleur, McCall, Nunez, Cuglievan, Tambaro, Petropoulos, Abdel-Azim and Mahadeo.
PY - 2022/10/24
Y1 - 2022/10/24
N2 - Tisagenlecleucel is associated with remarkable outcomes in treating patients up to the age of 25 years with refractory B-cell acute lymphoblastic leukemia (ALL). Yet, due to unique and potentially life-threatening complications, access remains limited to higher-resource and certified centers. Reports of inequity and related disparities in care are emerging. In this multicenter study of ALL patients admitted for anti-leukemia therapy, who required pediatric intensive care (ICU) support (n = 205), patients receiving tisagenlecleucel (n = 39) were compared to those receiving conventional chemotherapy (n = 166). The median time to ICU transfer was 6 (0–43) versus 1 (0–116) days, respectively (p < 0.0001). There was no difference in the use of vasopressor, ionotropic, sedating, and/or paralytic agents between groups, but use of dexamethasone was higher among tisagenlecleucel patients. Patients receiving tisagenlecleucel were more likely to have cardiorespiratory toxicity (p = 0.0002), but there were no differences in diagnostic interventions between both groups and/or differences in ICU length of stay and/or overall hospital survival. Toxicities associated with tisagenlecleucel are generally reversible, and our findings suggest that resource utilization once admitted to the ICU may be similar among patients with ALL receiving tisagenlecleucel versus conventional chemotherapy. As centers consider improved access to care and the feasibility of tisagenlecleucel certification, our study may inform strategic planning.
AB - Tisagenlecleucel is associated with remarkable outcomes in treating patients up to the age of 25 years with refractory B-cell acute lymphoblastic leukemia (ALL). Yet, due to unique and potentially life-threatening complications, access remains limited to higher-resource and certified centers. Reports of inequity and related disparities in care are emerging. In this multicenter study of ALL patients admitted for anti-leukemia therapy, who required pediatric intensive care (ICU) support (n = 205), patients receiving tisagenlecleucel (n = 39) were compared to those receiving conventional chemotherapy (n = 166). The median time to ICU transfer was 6 (0–43) versus 1 (0–116) days, respectively (p < 0.0001). There was no difference in the use of vasopressor, ionotropic, sedating, and/or paralytic agents between groups, but use of dexamethasone was higher among tisagenlecleucel patients. Patients receiving tisagenlecleucel were more likely to have cardiorespiratory toxicity (p = 0.0002), but there were no differences in diagnostic interventions between both groups and/or differences in ICU length of stay and/or overall hospital survival. Toxicities associated with tisagenlecleucel are generally reversible, and our findings suggest that resource utilization once admitted to the ICU may be similar among patients with ALL receiving tisagenlecleucel versus conventional chemotherapy. As centers consider improved access to care and the feasibility of tisagenlecleucel certification, our study may inform strategic planning.
KW - AYA (adolescents and young adults)
KW - CAR (chimeric antigen receptor) T-cell therapy
KW - Immunotherapy
KW - pediatric cancer
KW - Resource utilisation
UR - http://www.scopus.com/inward/record.url?scp=85141344900&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85141344900&partnerID=8YFLogxK
U2 - 10.3389/fonc.2022.1022901
DO - 10.3389/fonc.2022.1022901
M3 - Article
C2 - 36353531
AN - SCOPUS:85141344900
SN - 2234-943X
VL - 12
JO - Frontiers in Oncology
JF - Frontiers in Oncology
M1 - 1022901
ER -