Identification of nutritional risk in chimeric antigen receptor T-cell (CAR-T) therapy: Protein-energy malnutrition and its impact on patient outcomes.

Abstract

12158 Background: Protein-energy malnutrition (PEM), an imbalance between protein and energy intake and the body’s requirements, is highly prevalent in cancer, affecting 20–70% of patients, with an overall prevalence of approximately 41%. PEM and cachexia impair therapeutic efficacy, increase treatment-related toxicities, and worsen survival outcomes. Although CAR T-cell therapy has revolutionized oncology, its associated complications—such as cytokine release syndrome (CRS) and immune effector cell–associated neurotoxicity syndrome (ICANS) further affects nutritional status, creating a complex bidirectional relationship between PEM and CAR-T complications. This study utilizes the National Inpatient Sample (NIS) to assess nutritional status in CAR T-cell therapy recipients and potential impact on outcomes and treatment-related complications. Methods: A retrospective cohort study was conducted using the 2021–2023 National Inpatient Sample (NIS) database. Adult patients (aged ≥18 years) who were hospitalized and received CAR-T therapy were identified using ICD-10 codes and stratified according to the presence of PEM. The primary outcome was the inpatient mortality rate, while secondary outcomes included length of hospital stay, total hospital charges, incidence of CRS, ICANS, and other medical complications. Results: Among 10,690 hospitalized adult CAR-T recipients, 2,190 (20%) had PEM. In-hospital mortality in this group was 190 (9%). The PEM cohort was predominantly male (79%) and White (74%), with a mean age of 61.5 years. Compared to patients without PEM, those with PEM experienced higher in-hospital mortality (8% vs 1.2%; OR 7.2; P < 0.001), longer hospital stays (LHS) (24 vs 15 days; Coefficient 9.2; P < 0.001), and higher costs ($1,428,895 vs $1,106,642; Coefficient 322,253; P < 0.001) and more CAR-T-related complications, including CRS (44% vs 39%; OR 1.3; P < 0.05), ICANS (12% vs 7%; OR 1.7; P < 0.05), sepsis (OR 3.13; P < 0.001), stroke (OR 4; P < 0.001), and cardiovascular events (OR 1.6; P < 0.001). Conclusions: This analysis identifies PEM as a significant predictor of mortality, prolonged hospitalization, higher costs and increased complications among CAR-T recipients. This highlights baseline nutritional status as a critical outcome determinant. This emphasizes the need for pre-treatment nutritional screening and early, targeted interventions to break the vicious cycle of malnutrition, improve treatment tolerance, reduce adverse events, and optimize outcomes. Further studies should evaluate tailored nutritional strategies and supportive care to enhance CAR-T safety and efficacy.