A Multicenter Study of ICU Resource Utilization in Pediatric, Adolescent and Young Adult Patients Post CAR-T Therapy

Authors

Dristhi Ragoonanan
Saleh Bhar
Gopi Mohan
Fernando Beltramo
Sajad J Khazal
Caitlin Hurley
Clark Andersen
Steven Margossian
Sattva S Neelapu
Elizabeth Shpall
Cristina Gutierrez
Priti Tewari
Basirat Shoberu
Aimee Talleur
David McCall
Cesar Nunez
Branko Cuglievan
Francesco Paolo Tambaro
Demetrios Petropoulos
Hisham Abdel-Azim
Kris M Mahadeo

Publication Date

1-1-2022

Journal

Frontiers in Oncology

DOI

10.3389/fonc.2022.1022901

PMID

36353531

PMCID

PMC9638171

PubMedCentral® Posted Date

10-24-2022

PubMedCentral® Full Text Version

Post-print

Abstract

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.

Published Open-Access

yes

Recommended Citation

Ragoonanan, Dristhi; Bhar, Saleh; Mohan, Gopi; et al., "A Multicenter Study of ICU Resource Utilization in Pediatric, Adolescent and Young Adult Patients Post CAR-T Therapy" (2022). Faculty, Staff and Student Publications. 4885.
https://digitalcommons.library.tmc.edu/uthgsbs_docs/4885