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Outcomes of CAR-T Cell Therapy Recipients Admitted to the ICU: In Search for a Standard of Care—A Brief Overview and Meta-Analysis of Proportions
Objective: Our primary objective was to describe the baseline characteristics, main reasons for intensive care unit (ICU) admission, and interventions required in the ICU across patients who received CAR-T cell immunotherapy. The secondary objectives were to evaluate different outcomes (ICU mortalit...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MDPI
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10531736/ https://www.ncbi.nlm.nih.gov/pubmed/37763039 http://dx.doi.org/10.3390/jcm12186098 |
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author | Constantinescu, Catalin Moisoiu, Vlad Tigu, Bogdan Kegyes, David Tomuleasa, Ciprian |
author_facet | Constantinescu, Catalin Moisoiu, Vlad Tigu, Bogdan Kegyes, David Tomuleasa, Ciprian |
author_sort | Constantinescu, Catalin |
collection | PubMed |
description | Objective: Our primary objective was to describe the baseline characteristics, main reasons for intensive care unit (ICU) admission, and interventions required in the ICU across patients who received CAR-T cell immunotherapy. The secondary objectives were to evaluate different outcomes (ICU mortality) across patients admitted to the ICU after having received CAR-T cell therapy. Materials and Methods. We performed a medical literature review, which included MEDLINE, Embase, and Cochrane Library, of studies published from the inception of the databases until 2022. We conducted a systematic review with meta-analyses of proportions of several studies, including CAR-T cell-treated patients who required ICU admission. Outcomes in the meta-analysis were evaluated using the random-effects model. Results: We included four studies and analyzed several outcomes, including baseline characteristics and ICU-related findings. CAR-T cell recipients admitted to the ICU are predominantly males (62% CI-95% (57–66)). Of the total CAR-T cell recipients, 4% CI-95% (3–5) die in the hospital, and 6% CI-95% (4–9) of those admitted to the ICU subsequently die. One of the main reasons for ICU admission is acute kidney injury (AKI) in 15% CI-95% (10–19) of cases and acute respiratory failure in 10% CI-95% (6–13) of cases. Regarding the interventions initiated in the ICU, 18% CI-95% (13–22) of the CAR-T recipients required invasive mechanical ventilation during their ICU stay, 23% CI-95% (16–30) required infusion of vasoactive drugs, and 1% CI-95% (0.1–3) required renal replacement therapy (RRT). 18% CI-95% (13–22) of the initially discharged patients were readmitted to the ICU within 30 days, and the mean length of hospital stay is 22 days CI-95% (19–25). The results paint a current state of matter in CAR-T cell recipients admitted to the ICU. Conclusions: To better understand immunotherapy-related complications from an ICU standpoint, acknowledge the deteriorating patient on the ward, reduce the ICU admission rate, advance ICU care, and improve the outcomes of these patients, a standard of care and research regarding CAR-T cell-based immunotherapies should be created. Studies that are looking from the perspective of intensive care are highly warranted because the available literature regarding this area is scarce. |
format | Online Article Text |
id | pubmed-10531736 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
spelling | pubmed-105317362023-09-28 Outcomes of CAR-T Cell Therapy Recipients Admitted to the ICU: In Search for a Standard of Care—A Brief Overview and Meta-Analysis of Proportions Constantinescu, Catalin Moisoiu, Vlad Tigu, Bogdan Kegyes, David Tomuleasa, Ciprian J Clin Med Review Objective: Our primary objective was to describe the baseline characteristics, main reasons for intensive care unit (ICU) admission, and interventions required in the ICU across patients who received CAR-T cell immunotherapy. The secondary objectives were to evaluate different outcomes (ICU mortality) across patients admitted to the ICU after having received CAR-T cell therapy. Materials and Methods. We performed a medical literature review, which included MEDLINE, Embase, and Cochrane Library, of studies published from the inception of the databases until 2022. We conducted a systematic review with meta-analyses of proportions of several studies, including CAR-T cell-treated patients who required ICU admission. Outcomes in the meta-analysis were evaluated using the random-effects model. Results: We included four studies and analyzed several outcomes, including baseline characteristics and ICU-related findings. CAR-T cell recipients admitted to the ICU are predominantly males (62% CI-95% (57–66)). Of the total CAR-T cell recipients, 4% CI-95% (3–5) die in the hospital, and 6% CI-95% (4–9) of those admitted to the ICU subsequently die. One of the main reasons for ICU admission is acute kidney injury (AKI) in 15% CI-95% (10–19) of cases and acute respiratory failure in 10% CI-95% (6–13) of cases. Regarding the interventions initiated in the ICU, 18% CI-95% (13–22) of the CAR-T recipients required invasive mechanical ventilation during their ICU stay, 23% CI-95% (16–30) required infusion of vasoactive drugs, and 1% CI-95% (0.1–3) required renal replacement therapy (RRT). 18% CI-95% (13–22) of the initially discharged patients were readmitted to the ICU within 30 days, and the mean length of hospital stay is 22 days CI-95% (19–25). The results paint a current state of matter in CAR-T cell recipients admitted to the ICU. Conclusions: To better understand immunotherapy-related complications from an ICU standpoint, acknowledge the deteriorating patient on the ward, reduce the ICU admission rate, advance ICU care, and improve the outcomes of these patients, a standard of care and research regarding CAR-T cell-based immunotherapies should be created. Studies that are looking from the perspective of intensive care are highly warranted because the available literature regarding this area is scarce. MDPI 2023-09-21 /pmc/articles/PMC10531736/ /pubmed/37763039 http://dx.doi.org/10.3390/jcm12186098 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Review Constantinescu, Catalin Moisoiu, Vlad Tigu, Bogdan Kegyes, David Tomuleasa, Ciprian Outcomes of CAR-T Cell Therapy Recipients Admitted to the ICU: In Search for a Standard of Care—A Brief Overview and Meta-Analysis of Proportions |
title | Outcomes of CAR-T Cell Therapy Recipients Admitted to the ICU: In Search for a Standard of Care—A Brief Overview and Meta-Analysis of Proportions |
title_full | Outcomes of CAR-T Cell Therapy Recipients Admitted to the ICU: In Search for a Standard of Care—A Brief Overview and Meta-Analysis of Proportions |
title_fullStr | Outcomes of CAR-T Cell Therapy Recipients Admitted to the ICU: In Search for a Standard of Care—A Brief Overview and Meta-Analysis of Proportions |
title_full_unstemmed | Outcomes of CAR-T Cell Therapy Recipients Admitted to the ICU: In Search for a Standard of Care—A Brief Overview and Meta-Analysis of Proportions |
title_short | Outcomes of CAR-T Cell Therapy Recipients Admitted to the ICU: In Search for a Standard of Care—A Brief Overview and Meta-Analysis of Proportions |
title_sort | outcomes of car-t cell therapy recipients admitted to the icu: in search for a standard of care—a brief overview and meta-analysis of proportions |
topic | Review |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10531736/ https://www.ncbi.nlm.nih.gov/pubmed/37763039 http://dx.doi.org/10.3390/jcm12186098 |
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