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A multicenter study of ICU resource utilization in pediatric, adolescent and young adult patients post CAR-T therapy

Tisagenlecleucel is associated with remarkable outcomes in treating patients up to the age of 25 years with refractory B-cell acute lymphoblastic leukemia (ALL). Yet, due to unique and potentially life-threatening complications, access remains limited to higher-resource and certified centers. Report...

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Autores principales: Ragoonanan, Dristhi, Bhar, Saleh, Mohan, Gopi, Beltramo, Fernando, Khazal, Sajad J., Hurley, Caitlin, Andersen, Clark, Margossian, Steven, Neelapu, Sattva S., Shpall, Elizabeth, Gutierrez, Cristina, Tewari, Priti, Shoberu, Basirat, Talleur, Aimee, McCall, David, Nunez, Cesar, Cuglievan, Branko, Tambaro, Francesco Paolo, Petropoulos, Demetrios, Abdel-Azim, Hisham, Mahadeo, Kris M.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9638171/
https://www.ncbi.nlm.nih.gov/pubmed/36353531
http://dx.doi.org/10.3389/fonc.2022.1022901
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author Ragoonanan, Dristhi
Bhar, Saleh
Mohan, Gopi
Beltramo, Fernando
Khazal, Sajad J.
Hurley, Caitlin
Andersen, Clark
Margossian, Steven
Neelapu, Sattva S.
Shpall, Elizabeth
Gutierrez, Cristina
Tewari, Priti
Shoberu, Basirat
Talleur, Aimee
McCall, David
Nunez, Cesar
Cuglievan, Branko
Tambaro, Francesco Paolo
Petropoulos, Demetrios
Abdel-Azim, Hisham
Mahadeo, Kris M.
author_facet Ragoonanan, Dristhi
Bhar, Saleh
Mohan, Gopi
Beltramo, Fernando
Khazal, Sajad J.
Hurley, Caitlin
Andersen, Clark
Margossian, Steven
Neelapu, Sattva S.
Shpall, Elizabeth
Gutierrez, Cristina
Tewari, Priti
Shoberu, Basirat
Talleur, Aimee
McCall, David
Nunez, Cesar
Cuglievan, Branko
Tambaro, Francesco Paolo
Petropoulos, Demetrios
Abdel-Azim, Hisham
Mahadeo, Kris M.
author_sort Ragoonanan, Dristhi
collection PubMed
description Tisagenlecleucel is associated with remarkable outcomes in treating patients up to the age of 25 years with refractory B-cell acute lymphoblastic leukemia (ALL). Yet, due to unique and potentially life-threatening complications, access remains limited to higher-resource and certified centers. Reports of inequity and related disparities in care are emerging. In this multicenter study of ALL patients admitted for anti-leukemia therapy, who required pediatric intensive care (ICU) support (n = 205), patients receiving tisagenlecleucel (n = 39) were compared to those receiving conventional chemotherapy (n = 166). The median time to ICU transfer was 6 (0–43) versus 1 (0–116) days, respectively (p < 0.0001). There was no difference in the use of vasopressor, ionotropic, sedating, and/or paralytic agents between groups, but use of dexamethasone was higher among tisagenlecleucel patients. Patients receiving tisagenlecleucel were more likely to have cardiorespiratory toxicity (p = 0.0002), but there were no differences in diagnostic interventions between both groups and/or differences in ICU length of stay and/or overall hospital survival. Toxicities associated with tisagenlecleucel are generally reversible, and our findings suggest that resource utilization once admitted to the ICU may be similar among patients with ALL receiving tisagenlecleucel versus conventional chemotherapy. As centers consider improved access to care and the feasibility of tisagenlecleucel certification, our study may inform strategic planning.
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spelling pubmed-96381712022-11-08 A multicenter study of ICU resource utilization in pediatric, adolescent and young adult patients post CAR-T therapy Ragoonanan, Dristhi Bhar, Saleh Mohan, Gopi Beltramo, Fernando Khazal, Sajad J. Hurley, Caitlin Andersen, Clark Margossian, Steven Neelapu, Sattva S. Shpall, Elizabeth Gutierrez, Cristina Tewari, Priti Shoberu, Basirat Talleur, Aimee McCall, David Nunez, Cesar Cuglievan, Branko Tambaro, Francesco Paolo Petropoulos, Demetrios Abdel-Azim, Hisham Mahadeo, Kris M. Front Oncol Oncology Tisagenlecleucel is associated with remarkable outcomes in treating patients up to the age of 25 years with refractory B-cell acute lymphoblastic leukemia (ALL). Yet, due to unique and potentially life-threatening complications, access remains limited to higher-resource and certified centers. Reports of inequity and related disparities in care are emerging. In this multicenter study of ALL patients admitted for anti-leukemia therapy, who required pediatric intensive care (ICU) support (n = 205), patients receiving tisagenlecleucel (n = 39) were compared to those receiving conventional chemotherapy (n = 166). The median time to ICU transfer was 6 (0–43) versus 1 (0–116) days, respectively (p < 0.0001). There was no difference in the use of vasopressor, ionotropic, sedating, and/or paralytic agents between groups, but use of dexamethasone was higher among tisagenlecleucel patients. Patients receiving tisagenlecleucel were more likely to have cardiorespiratory toxicity (p = 0.0002), but there were no differences in diagnostic interventions between both groups and/or differences in ICU length of stay and/or overall hospital survival. Toxicities associated with tisagenlecleucel are generally reversible, and our findings suggest that resource utilization once admitted to the ICU may be similar among patients with ALL receiving tisagenlecleucel versus conventional chemotherapy. As centers consider improved access to care and the feasibility of tisagenlecleucel certification, our study may inform strategic planning. Frontiers Media S.A. 2022-10-24 /pmc/articles/PMC9638171/ /pubmed/36353531 http://dx.doi.org/10.3389/fonc.2022.1022901 Text en Copyright © 2022 Ragoonanan, Bhar, Mohan, Beltramo, Khazal, Hurley, Andersen, Margossian, Neelapu, Shpall, Gutierrez, Tewari, Shoberu, Talleur, McCall, Nunez, Cuglievan, Tambaro, Petropoulos, Abdel-Azim and Mahadeo https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Oncology
Ragoonanan, Dristhi
Bhar, Saleh
Mohan, Gopi
Beltramo, Fernando
Khazal, Sajad J.
Hurley, Caitlin
Andersen, Clark
Margossian, Steven
Neelapu, Sattva S.
Shpall, Elizabeth
Gutierrez, Cristina
Tewari, Priti
Shoberu, Basirat
Talleur, Aimee
McCall, David
Nunez, Cesar
Cuglievan, Branko
Tambaro, Francesco Paolo
Petropoulos, Demetrios
Abdel-Azim, Hisham
Mahadeo, Kris M.
A multicenter study of ICU resource utilization in pediatric, adolescent and young adult patients post CAR-T therapy
title A multicenter study of ICU resource utilization in pediatric, adolescent and young adult patients post CAR-T therapy
title_full A multicenter study of ICU resource utilization in pediatric, adolescent and young adult patients post CAR-T therapy
title_fullStr A multicenter study of ICU resource utilization in pediatric, adolescent and young adult patients post CAR-T therapy
title_full_unstemmed A multicenter study of ICU resource utilization in pediatric, adolescent and young adult patients post CAR-T therapy
title_short A multicenter study of ICU resource utilization in pediatric, adolescent and young adult patients post CAR-T therapy
title_sort multicenter study of icu resource utilization in pediatric, adolescent and young adult patients post car-t therapy
topic Oncology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9638171/
https://www.ncbi.nlm.nih.gov/pubmed/36353531
http://dx.doi.org/10.3389/fonc.2022.1022901
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