CAR-T-associated Cardiovascular Events are Associated with Increased Resource Utilization
Abstract Body (Do not enter title and authors here): BACKGROUND: Chimeric antigen receptor T-cell (CAR-T) therapy targeting CD-19 utilizes ex-vivo engineered T-cells to treat refractory malignancies. Widespread CAR-T adoption is limited by resource utilization and cost, and CAR-T has also been associated with adverse cardiovascular events. Limited data exist exploring the relationship between CAR-T-associated cardiovascular events and resource utilization events (RUE).
OBJECTIVE: To evaluate whether CAR-T-associated cardiovascular events are associated with RUE.
METHODS: Records of patients treated with an FDA-approved CAR-T product between 2018 and 2022 at a single institution were reviewed. Cardiovascular events post-CAR-T were defined as arrhythmia, acute coronary syndrome, stroke, cardiovascular death, new cardiomyopathy, heart failure, or pericarditis. RUE was a composite of intensive care unit (ICU) transfer, prolonged length of stay (LOS; >75th cohort percentile), and unplanned 6-month readmission.
RESULTS: Of 117 patients, 30 (26%) experienced cardiovascular events over a median 16 (IQR 7-34) months follow-up. RUE occurred in 65 patients (56%): 28 (24%) ICU transfers, 23 (20%) prolonged LOS, and 48 (41%) readmissions. Those with RUE experienced subsequent higher mortality (62% vs. 21%, p≤0.001). Among patients who experienced cardiovascular events, 24 (80%) experienced RUEs. In a Cox model, cardiovascular events (HR 2.3, 95% CI 1.3-4.1) and high cancer burden (HR 2.1, 95% CI 1.3-3.5) were independently associated with increased RUE rate, after adjusting for age, Cytokine Release Syndrome grade ≥2, atrial fibrillation history, and CAR-T costimulatory domain.
CONCLUSION: CAR-T recipients who experience cardiovascular events also experience increased resource utilization events. Further prospective studies are needed to assess whether post-CAR-T cardiovascular event management and/or pre-therapy assessment may reduce resource utilization burden.
Song, Justin
( UCLA Medical Center
, Los Angeles
, California
, United States
)
Eradat, Herbert
( UCLA Medical Center
, Los Angeles
, California
, United States
)
Schiller, Gary
( UCLA Medical Center
, Los Angeles
, California
, United States
)
Devos, Sven
( UCLA Medical Center
, Los Angeles
, California
, United States
)
Timmerman, John
( UCLA Medical Center
, Los Angeles
, California
, United States
)
Stein-merlob, Ashley
( UCLA Medical Center
, Los Angeles
, California
, United States
)
Neilan, Tomas
( MASSACHUSETTS GENERAL HOSPITAL
, Boston
, Massachusetts
, United States
)
Larson, Sarah
( UCLA Medical Center
, Los Angeles
, California
, United States
)
Young, Patricia
( UCLA Medical Center
, Los Angeles
, California
, United States
)
Mahmood, Syed
( Saint Francis Hospital & Heart Center
, Roslyn
, New York
, United States
)
Yang, Eric
( UCLA Medical Center
, Los Angeles
, California
, United States
)
Vuong, Jacqueline
( Cedars-Sinai Medical Center
, Los Angeles
, California
, United States
)
Mead, Monica
( UCLA Medical Center
, Los Angeles
, California
, United States
)
Gornbein, Jeffrey
( UCLA Medical Center
, Los Angeles
, California
, United States
)
Rothberg, Michael
( UCLA Medical Center
, Los Angeles
, California
, United States
)
Pan, Chelsea
( UCLA Medical Center
, Los Angeles
, California
, United States
)
Dhaliwal, Jasmeet
( UCLA Medical Center
, Los Angeles
, California
, United States
)
Boiarsky, Jonathan
( UCLA Medical Center
, Los Angeles
, California
, United States
)
Gaut, Daria
( UCLA Medical Center
, Los Angeles
, California
, United States
)
Author Disclosures:
Justin Song:DO NOT have relevant financial relationships
| Herbert Eradat:No Answer
| Gary Schiller:No Answer
| SVEN DEVOS:No Answer
| John Timmerman:No Answer
| Ashley Stein-Merlob:DO NOT have relevant financial relationships
| Tomas Neilan:DO have relevant financial relationships
;
Consultant:Bristol-Myers Squibb:Active (exists now)
; Consultant:Parexel:Active (exists now)
; Consultant:Sanofi:Active (exists now)
; Research Funding (PI or named investigator):Abbott:Active (exists now)
; Research Funding (PI or named investigator):Bristol-Myers Squibb:Active (exists now)
; Consultant:Genentech:Active (exists now)
; Consultant:Roche:Active (exists now)
| Sarah Larson:No Answer
| Patricia Young:DO NOT have relevant financial relationships
| Syed Mahmood:DO have relevant financial relationships
;
Consultant:Medicure:Past (completed)
; Consultant:Health and Wellness Partners:Past (completed)
; Consultant:Nektar Therapeutics:Past (completed)
| Eric Yang:DO have relevant financial relationships
;
Research Funding (PI or named investigator):CSL Behring:Past (completed)
; Speaker:National Comprehensive Cancer Network:Past (completed)
; Consultant:Xencor:Past (completed)
; Speaker:Zoll Medical:Past (completed)
; Consultant:Edwards Lifesciences:Active (exists now)
; Research Funding (PI or named investigator):Amgen:Active (exists now)
; Research Funding (PI or named investigator):Bristol Myers Squibb:Active (exists now)
; Research Funding (PI or named investigator):Boehringer Ingelheim and Eli and Lilly:Past (completed)
| Jacqueline Vuong:No Answer
| Monica Mead:No Answer
| Jeffrey Gornbein:DO NOT have relevant financial relationships
| Michael Rothberg:DO NOT have relevant financial relationships
| Chelsea Pan:DO NOT have relevant financial relationships
| Jasmeet Dhaliwal:DO NOT have relevant financial relationships
| Jonathan Boiarsky:DO have relevant financial relationships
;
Individual Stocks/Stock Options:Tectonic Therapeutics :Active (exists now)
| Daria Gaut:No Answer
