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Acnew study published in Blood Advances demonstrates that patients with haematological cancers experienced a significant improvement in their reported well-being six months after receiving CAR T-cell therapy.
“CAR T-cell therapy has revolutionised the treatment of patients with relapsed and refractory blood cancers. But it remains a unique treatment with unique toxicities, including cytokine release syndrome, which is an inflammatory flu-like ailment, as well as neurologic toxicities. And these complications can take a toll on patients,” said Dr Connor Johnson, Oncologist at Massachusetts General Hospital, US, and lead study author. “Given the relatively new development of CAR T-cell therapy, there are a limited set of studies that have examined patient-reported outcomes in those receiving these treatments.”
To address this information deficit, the investigators conducted a longitudinal study of adults with hematologic malignancies receiving CAR T-cell at a single academic centre. They enrolled 103 patients aged 23-to-90 years with a blood cancer diagnosis from April of 2019 to November of 2021. Of these patients, 71 per cent were diagnosed with lymphoma, 28 per cent with myeloma, and 1 per cent
with B-cell acute lymphoblastic leukaemia. Patients eligible to receive CAR T-cell therapy were most commonly administered tisagenlecleucel (34 per cent), lisocabtagene maraleucel (16 per cent), axicabtagene ciloleucel (13 per cent), and idecabtagene vicleucel (12 per cent).
The researchers administered self-reported questionnaires measuring quality-of-life variables at time intervals including prior to CAR T-cell infusion, and one week, one month, three months, and six months after CAR T-cell infusion. Quality-of-life was measured using a 27-item questionnaire (the Functional Assessment of Cancer Therapy-General (FACT-G)), which measures quality-of-life factors using four different subscales (physical, functional, emotional, and social) at all time points. Psychological distress was measured using the Hospital Anxiety and Depression Scale (HADS), which assessed variables designed to measure anxiety and depression symptoms at all time points. Lastly, major depressive symptoms were also measured using the PHQ-9, and post-traumatic stress disorder symptoms were measured using the Post-Traumatic Stress Checklist. Researchers also recorded physical symptoms using the Edmonton Symptom Assessment System, which assessed pain, fatigue, drowsiness, nausea, appetite, dyspnoea, insomnia, trouble swallowing, and well-being over 24 hours.
Overall, 76 per cent of patients achieved remission and 33 per cent experienced immune effector cell-associated neurotoxicity syndrome, a common side-effect of CAR T-cell therapy. Of note, 38 per cent of patients did not survive the length of follow-up for the study.
Investigators were specifically interested in understanding how CAR T-cell therapy affected patient quality-of-life. They found that for most individuals, quality-of-life initially declined in the first week after the administration of CAR T-cell therapy (decreasing from a median baseline of 77.9 to 70.1), a time when treatment-related symptoms are typically at their peak, and then significantly increased (to a median of 83.7) by the six-month mark post infusion. Similarly, they found improvements in the physical symptom burden, as well as anxiety symptoms.
While most study participants ultimately experienced an improvement in their quality-of-life, roughly 20 per cent of patients experienced persistent physical and psychological symptoms, which at times were detrimental to quality-of-life.
Dr Johnson maintained that it is important to recognise the burden CAR T-cell therapy brings to some patients, to maximise the effectiveness of these therapies and improve care for all individuals living with haematologic malignancies.
“Here we show significant improvements in quality-of-life among patients with an array of blood cancer diagnoses, receiving a variety of CAR T-cell products,” said Dr Johnson. “However, we also identify a distinct subset of patients who have persistent physical and psychological symptom burden, even at the six-month post CAR T-cell time point. And I hope that these findings lead to additional interventions with a goal of improving the overall quality-of-life trajectory of all patients.”
Johnson PCC, Dhawale TM, Newcomb RA, Amonoo HL, Lavoie MW, Vaughn DM, et al. Longitudinal patient-reported outcomes in patients
receiving chimeric antigen receptor T-cell therapy. Blood Adv. 2023 Mar 30:bloodadvances.2022009117. doi: 10.1182/bloodadvances.2022009117
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