Chimeric antigen receptor T-cell therapy: Prospective observational study of unplanned emergency department presentations

Emerg Med Australas. 2023 Dec;35(6):1034-1037. doi: 10.1111/1742-6723.14300. Epub 2023 Sep 5.

Abstract

Objective: Chimeric antigen receptor T-cell (CAR-T) therapy is an emerging treatment for refractory hematologic malignancy. Unplanned ED presentations following CAR-T present the increasing need for an integrated model of care that allows for the early recognition of its specific complications.

Methods: This is a prospective observational study at a tertiary centre. CAR-T patients (n = 17) were universally enrolled into a study registry by treating providers. These patients were flagged by investigators to trigger a pop-up notification CAR-T information warning at ED triage. Medical records were reviewed 90 days for unplanned presentations, complications and patient-oriented outcomes.

Results: Patients receiving CAR-T frequently encountered toxicity within 7 days of therapy. This was typically mild and occurred in an inpatient setting. Medical record review revealed five unplanned ED presentations (that were recognised as post CAR-T) and not directly attributable to specific toxicities.

Conclusion: If CAR-T therapy is to be used more widely especially in an outpatient model of care, a standardised ED model of care for recognition of specific complications is needed.

Keywords: chimeric antigen receptor T-cell therapy; cytokine release syndrome; haematology; immune effector cell-associated neurotoxicity syndrome; unplanned presentation.

Publication types

  • Observational Study

MeSH terms

  • Cell- and Tissue-Based Therapy
  • Hematologic Neoplasms* / pathology
  • Hematologic Neoplasms* / therapy
  • Humans
  • Immunotherapy, Adoptive
  • Inpatients
  • Prospective Studies
  • Receptors, Chimeric Antigen*

Substances

  • Receptors, Chimeric Antigen