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. TITLE=A multicenter study of ICU resource utilization in pediatric, adolescent and young adult patients post CAR-T therapy JOURNAL=Frontiers in Oncology VOLUME=12 YEAR=2022 URL=https://www.frontiersin.org/journals/oncology/articles/10.3389/fonc.2022.1022901 DOI=10.3389/fonc.2022.1022901 ISSN=2234-943X 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.