Background
It is not clear if all Americans have benefitted equally from the availability of chimeric antigen receptor T‐cell (CART) therapy. We aimed to evaluate if demographic differences existed ...among adult patients who received CART therapy and to assess predictors of CART treatment outcomes.
Methods
Records of patients ≥18 years who received CART therapy for non‐Hodgkin’s lymphoma, acute lymphoblastic leukemia, and multiple myeloma in 2018 were evaluated in the National Inpatient Sample. Acute complications and inhospital mortality were compared between two groups of CART recipients: Whites and non‐Whites. Logistic regression analysis was used to evaluate the association between sociodemographic factors and inhospital mortality.
Results
Of 1275 CART recipients that met inclusion criteria, there were 40.4% of females, 66.9% of Whites, Blacks (4.2%), Hispanics (13.3%), Asians or Pacific Islanders (4.2%), and Native Americans (1.3%). Up to 96.8% of CART procedures were performed in urban teaching hospitals, and 85.3% of CART recipients lived in metropolitan counties. Non‐Whites, compared to Whites, were younger at the time of CART therapy (p < 0.001). The inhospital mortality rate was higher in non‐Whites, though not statistically significant (5.4% vs. 4.4%, p = 0.764). There were no differences in length of hospital stay, hospital charges, or rates of acute toxicities between the two race groups. We found no association between race and treatment outcomes. Gender, neurotoxicity, and Charlson Comorbidity Index were significant predictors of inhospital mortality.
Conclusions
CART therapy recipients in the United States were more likely to be Whites and more likely to be residents of metropolitan areas. These observed demographic differences were not associated with treatment outcomes or inhospital mortalities.
The first CART product was approved for commercial use in 2017, but it is not clear if all Americans have benefitted equally from the availability of CART therapies. In this retrospective study, we evaluated the demographic characteristics of CART therapy recipients for the year 2018. We found that racial minorities (especially Blacks) and people who live outside metropolitan areas were less likely to receive CART therapies.
•Nearly one-third of hospitalized patients who had chimeric antigen receptor T-cell therapy for acute lymphoblastic leukemia and aggressive lymphomas in 2018 had a neuropsychiatric disorder.•Females ...and patients with acute lymphoblastic leukemia are at higher risk for neuropsychiatric disorders during hospitalization for chimeric antigen receptor T-cell treatment.•Chimeric antigen receptor T-cell recipients who are mechanically ventilated are likely underdiagnosed with neuropsychiatric disorders.
To evaluate risk factors for neuropsychiatric disorders (NPD) in recipients of CART therapy.
Patients ≥ 18 years with acute lymphoblastic leukemia (ALL), and aggressive B-cell lymphomas who received CART in 2018 were evaluated. Patients with and without NPD were compared.
NPD was diagnosed in 31.2% of patients. Compared to patients without NPD, patients with NPD were likely to be females (P = 0.035) and have ALL (P = 0.039). NPD was significantly associated with female gender (OR = 2.03) and diagnosis of ALL (OR = 2.76). No association between NPD and outcomes.
Female gender and ALL were risk factors for NPD.
Although ibrutinib-associated atrial and ventricular arrhythmias have been well described, there is little information about ibrutinib’s effects on other electrocardiographic parameters, particularly ...the QT interval. Using our database of 137 patients treated with ibrutinib, we retrospectively identified 21 patients in whom an electrocardiogram (ECG) was obtained both prior to and after ibrutinib exposure. All traditional ECG parameters as well as QT dispersion were manually measured by an electrophysiologist. Compared to baseline ECGs, post ibrutinib ECGs demonstrated QT interval shortening from 386 ms to 356 ms (P = .007), corrected QT interval shortening using Bazett’s formula from 446 ms to 437 ms (P = .04), and corrected QT interval shortening using Fridericia’s formula from 425 ms to 407 ms (P = .003). QT dispersion also increased post ibrutinib exposure compared to baseline (39.8 ms vs 57.3 ms, P = .002). There was no significant change in other ECG parameters. In conclusion, both the absolute and corrected QT intervals significantly shortened after ibrutinib exposure, while there was a significant increase in QT dispersion. These findings may point to a common underlying electrophysiologic mechanism of ibrutinib-associated arrhythmias.
Patients with sickle cell disease are at risk of vaso-occlusive crises including acute chest syndrome (ACS) and pulmonary hypertension. ACS is a life-threatening complication of sickle cell disease ...and is associated with increased morbidity and mortality. It is known that pulmonary pressures increase during episodes of acute chest syndrome and may lead to acute right ventricular failure leading to increased morbidity and mortality. Given the paucity of randomized controlled trials, the management of ACS and pulmonary hypertension in the setting of a sickle cell crisis largely relies on expert opinion. We present a case of acute chest syndrome complicated by acute right ventricular failure that was managed with prompt red cell exchange transfusion with favorable clinical outcomes.
Chronic lymphocytic leukemia (CLL) is the most common leukemia. Combined agent chemotherapy is the current standard front-line treatment for physically fit patients with CLL. Use of chemotherapy can ...be complicated by significant toxicity, especially in patients with advanced age or comorbid conditions. Moreover, patients may relapse and become refractory to further chemotherapy. Immunotherapy targets the aberrant immunological processes in CLL without the toxicity of chemotherapy. Immunotherapeutic strategies can also be combined with chemotherapy to improve response rates in this incurable disease. In this review, we evaluate current and future immune-based options in the treatment of CLL.
Chronic lymphocytic leukemia (CLL), the most prevalent leukemia in the Western world, is predominantly a disease of older individuals who also have other comorbidities as well as declining organ and ...bone marrow reserve. Although chemoimmunotherapy is the frontline therapy for fit CLL patients who can tolerate the therapy, many elderly patients cannot tolerate such intense therapy.
The authors first reviewed the most recent findings concerning CLL cytogenetics, molecular biology, and prognostic models. They then surveyed recent and ongoing trials of novel CLL agents and strategies, with a focus on those most relevant to elderly patients.
Novel therapies, revised staging procedures, and careful assessment of individual patients' frailty and functional status will allow clinicians to provide optimal care management for older CLL patients.
Therapy for the elderly CLL population must be tailored to each patient's fitness level and comorbid conditions, with special consideration for the potential quality-of-life impacts of various treatment recommendations.
Chimeric antigen receptor T-cell (CAR-T) therapies have shown efficacy in treatment of relapsed/refractory multiple myeloma (MM). Neuropsychiatric disorders (NPD) in patients undergoing CAR-T have ...not been well described.
To evaluate prevalence of NPD in patients who underwent in-hospital CAR-T therapy for MM and explore association of NPD with in-hospital outcomes of CAR-T therapy.
Retrospective.
We evaluated NPD among patients undergoing in-hospital CAR-T therapy for MM in 2018 using data from the National Inpatient Sample (NIS). We applied discharge level weights to extrapolate findings to hospitalizations across the nation.
Hospitalizations for patients ≥ 18 years who received investigational CAR-T therapy for MM were selected from the NIS database using International Classification of Disease, Tenth Revision (ICD-10) procedure and diagnostic codes. Demographic and CAR-T treatment variables were collected. Regression models were fit to assess association of NPD with clinical variables, and odds ratios (OR) were reported.
The primary outcome was prevalence and distribution of NPD. The secondary outcome was association of NPD with CAR-T outcomes.
A total of 200 CAR-T procedures met inclusion criteria; 65% males, 71% Caucasians, and 15.8% African Americans, with a median age of 59 years. Most CAR-T procedures (95%) were performed in urban teaching hospitals. Prevalence of NPD was 27.5%. Anxiety was the most common NPD, then depression and insomnia. Patients with NPD, compared to those without, were more likely to have Charlson comorbidity index (CCI) > 3 (54.5% versus 20.7%, p= 0.01). There were no observed differences in the distribution of NPD with regard to race, age, gender, insurance, or prior receipt of bone marrow transplantation. Association was noted between NPD and CCI ≥ 3 (OR= 4.60, 95% CI= 1.29–16.40), between NPD and fever (OR= 0.16, 95% CI= 0.04–0.70). No significant association were found between NPD and neurotoxicity, in-hospital mortality, respiratory or renal failure, length of stay, or hospital charges.
One in every four patients who underwent CART therapy for MM in 2018 had NPD. Patients with multiple comorbidities were at higher risk, while patients with fever during CART therapy were likely underdiagnosed with NPD.
With the success of tyrosine kinase inhibitor (TKI) therapy for the treatment of patients with chronic myeloid leukemia (CML), CML is now treated as a chronic disease. As such, the community of ...oncologists may see patients with CML more often than the primary-care physician and must focus on long-term management of adverse events and adherence. BCR-ABL1 TKIs are effective therapies in CML but are associated with distinct safety profiles. Thus, selection of long-term treatment with any TKI requires assessment of patient comorbidities and regular monitoring to identify the potential emergence of adverse effects or new risk factors. With a focus on long-term safety, this review provides a holistic picture of the primary care needs of patients with CML, emphasizing on the importance of community oncologists who in many cases act as both oncologists and primary-care physicians.
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