Cargando…

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...

Descripción completa

Detalles Bibliográficos
Autores principales: Constantinescu, Catalin, Moisoiu, Vlad, Tigu, Bogdan, Kegyes, David, Tomuleasa, Ciprian
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
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
_version_ 1785111789820706816
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
work_keys_str_mv AT constantinescucatalin outcomesofcartcelltherapyrecipientsadmittedtotheicuinsearchforastandardofcareabriefoverviewandmetaanalysisofproportions
AT moisoiuvlad outcomesofcartcelltherapyrecipientsadmittedtotheicuinsearchforastandardofcareabriefoverviewandmetaanalysisofproportions
AT tigubogdan outcomesofcartcelltherapyrecipientsadmittedtotheicuinsearchforastandardofcareabriefoverviewandmetaanalysisofproportions
AT kegyesdavid outcomesofcartcelltherapyrecipientsadmittedtotheicuinsearchforastandardofcareabriefoverviewandmetaanalysisofproportions
AT tomuleasaciprian outcomesofcartcelltherapyrecipientsadmittedtotheicuinsearchforastandardofcareabriefoverviewandmetaanalysisofproportions