Critically Ill Patients Treated for Chimeric Antigen Receptor-Related Toxicity: A Multicenter Study*. Issue 1 (January 2022)

• Record Type: Journal Article
• Authors: Gutierrez, Cristina; Brown, Anne Rain T.; May, Heather P.; Beitinjaneh, Amer; Stephens, R. Scott; Rajendram, Prabalini; Nates, Joseph L.; Pastores, Stephen M.; Dharshan, Ananda; de Moraes, Alice Gallo; Hensley, Matthew K.; Feng, Lei; Brudno, Jennifer N.; Athale, Janhavi; Ghosh, Monalisa; Kochenderfer, James N.; Arias, Alejandro S.; Lin, Yi; McEvoy, Colleen; Mead, Elena; Westin, Jason; Kostelecky, Natalie; Mian, Agrima; Herr, Megan M.
• Is Part Of: Critical care medicine. Volume 50:Issue 1(2022)
• Publication Date: 2022-01
• Subjects: chimeric antigen receptor T-cell -- cytokine release syndrome -- immune effector cell-associated neurotoxicity syndrome -- intensive care unit -- outcomes; Critical care medicine -- Periodicals; Soins intensifs -- Périodiques; 616.028
• DOI: 10.1097/CCM.0000000000005149
• Languages: English
• ISSNs: 0090-3493

Abstract

Abstract : OBJECTIVES: To report the epidemiology, treatments, and outcomes of adult patients admitted to the ICU after cytokine release syndrome or immune effector cell-associated neurotoxicity syndrome. DESIGN: Retrospective cohort study SETTING: Nine centers across the U.S. part of the chimeric antigen receptor-ICU initiative. PATIENTS: Adult patients treated with chimeric antigen receptor T-cell therapy who required ICU admission between November 2017 and May 2019. INTERVENTIONS: Demographics, toxicities, specific interventions, and outcomes were collected. RESULTS: One-hundred five patients treated with axicabtagene ciloleucel required ICU admission for cytokine release syndrome or immune effector cell-associated neurotoxicity syndrome during the study period. At the time of ICU admission, the majority of patients had grade 3–4 toxicities (66.7%); 15.2% had grade 3–4 cytokine release syndrome and 64% grade 3–4 immune effector cell-associated neurotoxicity syndrome. During ICU stay, cytokine release syndrome was observed in 77.1% patients and immune effector cell-associated neurotoxicity syndrome in 84.8% of patients; 61.9% patients experienced both toxicities. Seventy-nine percent of patients developed greater than or equal to grade 3 toxicities during ICU stay, however, need for vasopressors (18.1%), mechanical ventilation (10.5%), and dialysis (2.9%) was uncommon. Immune Effector Cell-Associated Encephalopathy score less than 3 (69.7%), seizures (20.2%), status epilepticus (5.7%), motor deficits (12.4%), and cerebral edema (7.9%) were more prevalent. ICU mortality was 8.6%, with only three deaths related to cytokine release syndrome or immune effector cell-associated neurotoxicity syndrome. Median overall survival time was 10.4 months (95% CI, 6.64–not available mo). Toxicity grade or organ support had no impact on overall survival; higher cumulative corticosteroid doses were associated to decreased overall and progression-free survival. CONCLUSIONS: This is the first study to describe a multicenter cohort of patients requiring ICU admission with cytokine release syndrome or immune effector cell-associated neurotoxicity syndrome after chimeric antigen receptor T-cell therapy. Despite severe toxicities, organ support and in-hospital mortality were low in this patient population. Abstract : Supplemental Digital Content is available in the text.