Hybrid Model of CAR T-Cell Therapy May Help Manage Treatment-Related Infections

Infection prevention and management is an area that, if addressed, would improve outcomes in patients receiving CAR T-cell therapy, according to Nausheen Ahmed, MD, lead author of a Blood Advances retrospective study.

CancerNetwork® spoke with Ahmed, an associate professor in the Division of Hematologic Malignancies and Cellular Therapeutics at the University of Kansas Medical Center. She conveyed that addressing treatment-emergent infections following CAR T-cell therapy is an opportunity that may be resolved by adopting a hybrid model of care between physicians and specialized care facilities.

Ahmed highlighted infections following CAR T-cell therapies were an area where differences could be made in patient outcomes. To address this, she emphasized a hybrid model of patient care, where specialized care facilities worked in conjunction with primary care physicians to help devise strategies to manage the frequency and severity of infections.

The retrospective study reviewed data from 475 patients across 9 centers who received CAR T therapy for relapsed or refractory large B-cell lymphoma from 2018 to 2023. Patients received either axicabtagene ciloleucel (axi-cel; Yescarta; n = 216), tisagenlecleucel (tisa-cel; Kymriah; n = 158), and lisocabtagene maraleucel (liso-cel; Breyanzi; n = 101).

Non-relapse mortality (NRM) was defined as death due to causes unrelated to disease progression and was commonly associated with infectious complications. New-onset CRS and ICANS were portrayed as percentages of patient populations at risk.

Data from the study show new-onset CRS and ICANS, respectively, occurred in 0% and 0.7% of patients with B-cell non-Hodgkin lymphoma (NHL) at 2 weeks following CAR T-cell infusion. Additionally, no new cases of CRS occurred after 2 weeks, with 1 additional incidence of ICANS occurring week 3. Additionally, all-cause and non-relapse mortalities, respectively, occurred in 42.8% and 9.5% of all patients, including 46% and 12% of axi-cel recipients, 48% and 7% of tisa-cel recipients, and 27% and 9% of liso-cel recipients (P = .0011; P = .3150).

Transcript:

The main take home here is that we have a [long way to go] in order to improve outcomes for these patients who are receiving CAR T-cell therapy. Specifically, one of the areas where we can make a difference is infection prevention and management. [Considering] the way things have been divided into such blocks of time [before patients] go to the referring physician, there may be a gap in that transition. There has to be more of a hybrid model of care.

There has to be more involvement of our referring doctors or community doctors in detecting and managing these infections or working with the specialized center in order to bypass the [emergency room] with other strategies to help these patients. That's going to be important. If there are enough data to say that the patients do not need extra restrictions beyond 2 weeks, which is what our studies show, then reconsidering the requirements will be one step towards decreasing disparities in access [to CAR T-cell therapy]. There are many other things that can be done at many other levels. This will be one of the things that I will be looking forward to seeing [progress].

Reference

Ahmed N, Wesson W, Lutfi F, et al. Optimizing the post-CAR T monitoring period in recipients of axicabtagene ciloleucel, tisagenlecleucel, and lisocabtagene maraleucel. Blood Advances. Published online July 24, 2024. doi:10.1182/bloodadvances.2023012549