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Research Letter
May 5, 2022

Assessment of Hospitalizations and Emergency Department Visits After Chimeric Antigen Receptor T-Cell Therapy Among Commercially Insured Patients

Author Affiliations
  • 1Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham
  • 2Division of Hematology and Oncology, University of Alabama at Birmingham, Birmingham
  • 3Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston
  • 4Division of Pediatric Oncology, University of Alabama at Birmingham, Birmingham
JAMA Oncol. 2022;8(7):1068-1070. doi:10.1001/jamaoncol.2022.1044

Chimeric antigen receptor T (CAR) T-cell therapy has transformed the treatment of relapsed and refractory hematologic malignancies.1 However, this treatment carries notable toxicity risks, including cytokine release syndrome, neurologic complications, and infections,2,3 and potentially greater intensive health care use.1,4 Real-world data on health care use after hospital discharge from CAR T-cell infusion are lacking but are needed for risk-stratified disease management strategies.4 We examined rehospitalizations and emergency department (ED) visits during the first 12 months after hospitalization for CAR T-cell infusion among commercially insured patients.

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    1 Comment for this article
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    Need for specific data report & analysis
    Saeed Taheri, M.D. | NLMJ
    Invaluable data has been omitted from the report. In a couple of systematic reviews, I analyzed associates of significant adverse events (AEs) associated with CAR therapy. Neurotoxicity, maybe the most important AEs associated with the highest mortality measures especially in the recipients of CD19 CARs (as in your report), had been found to be associated with the cancer type, CAR structure especially costimulatory domain, CAR T cell infused doses, lymphodepletion regimen, infused CAR cell phenotypes, and increased serum cytokine levels [1]. Likewise, cytokine release syndrome (CRS) of high grades were associated with mortality, with age of the recipients, CAR dosage, lymphodepletion regimen, tumor type, and CAR structure (costimulatory domain) reported as significant associates of CRS. A major disparity between neurotoxicity and CRS in their associates was the employment of cyclophosphamide plus fludarabine which was significantly associated with higher neurotoxicity while lower CRS rates [1,2]. All these data coming from meta-analysis of 51 (NT) and 79 (CRS) series, respectively, reported by several centers around the world employing quite diverse methodologies in their approaches, and therefore is needed to be confirmed or refuted in large series from centers with more consistent approaches. Your large series of CAR therapy in centers from one university provides invaluable opportunity in this regard.

    References:
    1. Taheri S. CAR driving neurotoxicity. N. Lahij. Med. J. 2020; 4: 1-2.
    2. Taheri S. Cytokine Release Syndrome after Chimeric Antigen Receptor (CAR) Transduced T-Cell Therapy in Cancers: Systematic Review. Saudi J Kidney Dis Transpl. 2022 (In press).
    CONFLICT OF INTEREST: None Reported
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