Inpatient burden of chimeric antigen receptor T-cell therapy: A National Inpatient Sample study.

Abstract

e23351 Background: Chimeric Antigen Receptor T-Cell (CAR-T) Therapy has emerged as the groundbreaking therapy for hematologic malignancies. Despites its efficacy, CAR-T therapy is associated with significant cardiac or neurological side effects have been reported. However, inpatient burden in CAR-T related adverse effects has not been explored. This study aims to address the gap in current research by analyzing inpatient burden in CAR-T using National Inpatient Sample (NIS) 2022. Methods: We included patients 18 years or older in NIS 2022 and conducted a retrospective analysis. Cancer diagnoses were identified using the Clinical Classification Software (CCS) codes. Hospitalization mortality, severity, length of stay (LOS), and costs were analyzed using R. Results: Most of the patients were equal or older than 18 years for those who received CAR-T (95.61%). Multiple myeloma (MM) was the most common disease type among CAR-T patients (185/763 patients, 24.25%) followed by diffuse large B cell lymphoma (DLBCL) (70/763 patients, 9.17%) and acute lymphoblastic leukemia (ALL) (40/896 patients, 5.24%). About two thirds of CAR-T patients were males (493/763 patients, 64.61%). About six out of ten CAR-T patients developed cytokine release syndrome (CRS) (470/763 patients, 61.60%). Patients with CRS grade 2 or greater showed significantly longer median LOS than those who are without CRS (15 vs 13 days, p = 0.003). 26.08% of CAR-T patients were diagnosed with immune effector cell-associated neurotoxicity syndrome (ICANS). The median hospital costs were 2.46% higher for those who developed CRS than those who did not ($1.37 million vs $1.34 million). Grade 4 or 5 CRS caused statistically significant high mortality during hospitalizations compared to CAR-T patients without CRS grade 4 or 5 (44.44% vs 1.46%, p = 0.041). CAR-T patients who required intubation or vasopressors had a longer median LOS (intubation; 13 vs 29.5 days, p = 0.003, vasopressor; 13 vs 22 days, p = 0.048). CAR-T patients who required vasopressors during hospitalization had 29.08% of additional charges compared who did not (Median hospital charges $1.90 million vs $1.35 million). Conclusions: Inpatient burden of CAR-T was higher in patients who experienced severe side effects such as CRS or needed intubation or vasopressors during hospitalization. Further directions should focus on developing strategies to mitigate the adverse effects and improve patients’ outcomes, ultimately enhancing the safety and effectiveness of CAR-T therapy.