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Resource utilization in patients with large B-cell lymphoma receiving tisagenlecleucel and axicabtagene ciloleucel

Bone Marrow Transplantation volume 58, pages 590–593 (2023)Cite this article

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Chimeric antigen receptor (CAR) T-cell therapy for patients with relapsed/refractory (r/r) large B-cell lymphoma (LBCL) is currently administered at a limited number of specialized cancer centers, and primarily in the inpatient setting. The process of insurance approval, production, and delivery of CAR T-cells is logistically complex and associated with significant inpatient and outpatient resource utilization [1,2,3]. Toxicities are relatively common and approximately 30–40% patients may require intensive care unit (ICU) admission for complications such as cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS) [4, 5]. The resource utilization and costs of treatment and associated hospitalization are substantial, which may limit widespread use [6,7,8]. Resource utilization among different types of CAR T-cell products has not been well described [9, 10]. In this study, we compared institutional healthcare resources used around anti-CD19 CAR T-cell products tisagenlecleucel (tisa-cel) and axicabtagene ciloleucel (axi-cel) infusion and identified factors that led to longer hospitalization during the first 100 days of therapy.

We retrospectively reviewed medical records of consecutive adult patients with r/r LBCL treated with tisa-cel or axi-cel from May 2018 to December 2021. Tisa-cel was available at our center after October 2019, prior to which all eligible patients received axi-cel; after this date, the two products were used based on physician discretion. Data on baseline characteristics were collected from our electronic health record. Comorbidities were assessed using the Hematopoietic Cell Transplantation-Comorbidity Index (HCT-CI) [11]. CAR T-cell therapy related toxicities were graded and managed according to standard criteria [12]. Toxicity grades were recorded on each day of hospital stay and the daily maximum grade was used for comparison between groups.

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Data availability

Data to support the findings of this research can be made available by the corresponding author upon reasonable request.

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Authors and Affiliations

  1. Department of Internal Medicine, Cleveland Clinic, Cleveland, OH, USA

    Agrima Mian

  2. Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA

    Wei Wei

  3. Blood and Marrow Transplant Program, Department of Hematology and Medical Oncology, Cleveland Clinic, Cleveland, OH, USA

    Betty K. Hamilton, Allison M. Winter, Jack Khouri, Brad Pohlman, Aaron T. Gerds, Deepa Jagadeesh, Faiz Anwer, Matt Kalaycio, Robert M. Dean, Ronald Sobecks, Paolo F. Caimi & Brian T. Hill

  4. Sarah Cannon, Nashville, TN, USA

    Navneet S. Majhail

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  1. Agrima Mian
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Contributions

AM collected clinical information, interpreted results, and wrote the manuscript. WW performed statistical analysis. NSM conceived the research and edited the manuscript drafts. All other authors edited and reviewed the final manuscript prior to submission.

Corresponding author

Correspondence to Navneet S. Majhail.

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Competing interests

NSM serves as a consultant for Anthem, Inc. BTH and PFC have received research funding and consulting feeds from Kite/Gilead and Novartis. AM received funding from ASH HONORS Grant for year 2022–2023.

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Mian, A., Wei, W., Hamilton, B.K. et al. Resource utilization in patients with large B-cell lymphoma receiving tisagenlecleucel and axicabtagene ciloleucel. Bone Marrow Transplant 58, 590–593 (2023). https://doi.org/10.1038/s41409-023-01934-4

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