دورية أكاديمية
Outcomes in patients treated with chimeric antigen receptor T-cell therapy who were admitted to intensive care (CARTTAS): an international, multicentre, observational cohort study.
| العنوان: | Outcomes in patients treated with chimeric antigen receptor T-cell therapy who were admitted to intensive care (CARTTAS): an international, multicentre, observational cohort study. |
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| المؤلفون: | Azoulay É; Critical Care Department, APHP, Hôpital Saint-Louis, University of Paris, Paris, France. Electronic address: elie.azoulay@aphp.fr., Castro P; Medical Intensive Care Unit, Hospital Clínic of Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain., Maamar A; Critical Care and Infectious Diseases Department, Rennes University Hospital, Rennes, France; INSERM CIC-1414, Faculté de Médecine, Université Rennes 1, Rennes, France., Metaxa V; Department of Critical Care, King's College Hospital NHS Foundation Trust, London, UK., de Moraes AG; Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA., Voigt L; Department of Anesthesiology, Pain, and Critical Care Medicine, Memorial Sloan Kettering Cancer Centre, New York City, NY, USA; Department of Anesthesiology, Weill Cornell Medical College, New York City, NY, USA., Wallet F; Critical Care Department, HCL, Hôpital Lyon Sud, University of Lyon, Lyon, France., Klouche K; Critical Care Department, Hôpital Lapeyronie, University of Montpellier, Montpellier, France., Picard M; Critical Care Department, Institut Universitaire du Cancer de Toulouse-Oncopole, University Teaching Hospital of Toulouse, Toulouse, France., Moreau AS; Critical Care Department, Lille University Salengro Hospital, Lille, France., Van De Louw A; Division of Pulmonary and Critical Care Medicine, Penn State Health Milton S Hershey Medical Centre, Hershey, PA, USA., Seguin A; Critical Care Department, Nantes University Hospital, Nantes, France., Mokart D; Critical Care Department, Institut Paoli-Calmettes, Marseille, France., Chawla S; Department of Anesthesiology, Pain, and Critical Care Medicine, Memorial Sloan Kettering Cancer Centre, New York City, NY, USA; Department of Anesthesiology, Weill Cornell Medical College, New York City, NY, USA., Leroy J; Critical Care Department, APHP, Hôpital Saint-Louis, University of Paris, Paris, France., Böll B; Department I of Internal Medicine, Haematology and Oncology, Intensive Care Medicine, Centre for Integrated Oncology Aachen Bonn Cologne Dusseldorf, University of Cologne, Cologne, Germany., Issa N; Critical Care Department, Hôpital Saint-André, University of Bordeaux, Bordeaux, France., Levy B; Service de Médecine Intensive et Réanimation Brabois, CHRU Nancy, Pôle Cardio-Médico-Chirurgical, Vandoeuvre-les-Nancy, INSERM U1116, Faculté de Médecine, Vandoeuvre-les-Nancy, France., Hemelaar P; Department of Intensive Care Medicine, Radboud University Medical Centre, Nijmegen, Netherlands., Fernandez S; Medical Intensive Care Unit, Hospital Clínic of Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain., Munshi L; Interdepartmental Division of Critical Care Medicine, Sinai Health System, University of Toronto, Toronto, ON, Canada., Bauer P; Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA., Schellongowski P; Intensive Care Unit 13i2, Department of Medicine I, Medical University of Vienna, Centre of Excellence of Medical Intensive Care (CEMIC), Vienna, Austria., Joannidis M; Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Innsbruck, Austria., Moreno-Gonzalez G; Intensive Care Unit, Bellvitge University Hospital, Catalan Institute of Oncology L'Hospitalet, Bellvitge Biomedical Research Institute, University of Barcelona, Barcelona, Spain., Galstian G; Department of Intensive Care of the National Research Centre for Haematology, Moscow Russia., Darmon M; Critical Care Department, APHP, Hôpital Saint-Louis, University of Paris, Paris, France., Valade S; Critical Care Department, APHP, Hôpital Saint-Louis, University of Paris, Paris, France. |
| مؤلفون مشاركون: | Nine-I investigators |
| المصدر: | The Lancet. Haematology [Lancet Haematol] 2021 May; Vol. 8 (5), pp. e355-e364. |
| نوع المنشور: | Journal Article; Observational Study |
| اللغة: | English |
| بيانات الدورية: | Publisher: Elsevier Ltd Country of Publication: England NLM ID: 101643584 Publication Model: Print Cited Medium: Internet ISSN: 2352-3026 (Electronic) Linking ISSN: 23523026 NLM ISO Abbreviation: Lancet Haematol Subsets: MEDLINE |
| أسماء مطبوعة: | Original Publication: [Oxford] : Elsevier Ltd., [2014]- |
| مواضيع طبية MeSH: | Cytokine Release Syndrome/*etiology , Immunotherapy, Adoptive/*adverse effects , Neurotoxicity Syndromes/*etiology, Adult ; Critical Care ; Female ; Follow-Up Studies ; Humans ; Intensive Care Units ; Lymphoma, Large B-Cell, Diffuse/mortality ; Lymphoma, Large B-Cell, Diffuse/therapy ; Male ; Middle Aged ; Multiple Myeloma/mortality ; Multiple Myeloma/therapy ; Precursor Cell Lymphoblastic Leukemia-Lymphoma/mortality ; Precursor Cell Lymphoblastic Leukemia-Lymphoma/therapy ; Proportional Hazards Models ; Registries ; Severity of Illness Index ; Survival Rate ; Treatment Outcome |
| مستخلص: | Background: Chimeric antigen receptor (CAR) T-cell therapy can induce side-effects such as cytokine release syndrome and immune effector cell-associated neurotoxicity syndrome (ICANS), which often require intensive care unit admission. The aim of this study was to describe management of critically ill CAR T-cell recipients in intensive care. Methods: This international, multicentre, observational cohort study was done in 21 intensive care units in France, Spain, the USA, the UK, Russia, Canada, Germany, and Austria. Eligible patients were aged 18 years or older; had received CAR T-cell therapy in the past 30 days; and had been admitted to intensive care for any reason. Investigators retrospectively included patients admitted between Feb 1, 2018, and Feb 1, 2019, and prospectively included patients admitted between March 1, 2019, and Feb 1, 2020. Demographic, clinical, laboratory, treatment, and outcome data were extracted from medical records. The primary endpoint was 90-day mortality. Factors associated with mortality were identified using a Cox proportional hazard model. Findings: 942 patients received CAR T-cell therapy, of whom 258 (27%) required admission to intensive care and 241 (26%) were included in the analysis. Admission to intensive care was needed within median 4·5 days (IQR 2·0-7·0) of CAR T-cell infusion. 90-day mortality was 22·4% (95% CI 17·1-27·7; 54 deaths). At initial evaluation on admission, isolated cytokine release syndrome was identified in 101 patients (42%), cytokine release syndrome and ICANS in 93 (39%), and isolated ICANS in seven (3%) patients. Grade 3-4 cytokine release syndrome within 1 day of admission to intensive care was found in 50 (25%) of 200 patients and grade 3-4 ICANS in 38 (35%) of 108 patients. Bacterial infection developed in 30 (12%) patients. Life-saving treatments were used in 75 (31%) patients within 24 h of admission to intensive care, primarily vasoactive drugs in 65 (27%) patients. Factors independently associated with 90-day mortality by multivariable analysis were frailty (hazard ratio 2·51 [95% CI 1·37-4·57]), bacterial infection (2·12 [1·11-4·08]), and lifesaving therapy within 24 h of admission (1·80 [1·05-3·10]). Interpretation: Critical care management is an integral part of CAR T-cell therapy and should be standardised. Studies to improve infection prevention and treatment in these high-risk patients are warranted. Funding: Groupe de Recherche Respiratoire en Réanimation Onco-Hématologique. Competing Interests: Declaration of interests EA has received personal fees and non-financial support from Pfizer, Gilead, Ablynx, Baxter, Alexion, and grants from Fisher & Payckle and Merck Sharp & Dohme, outside the submitted work. BL has received grants and personal fees from Amomed and Baxter, and personal fees from Novartis, outside the submitted work. BB has received personal fees from Johnson & Johnson and Novartis, grants and personal fees from Astellas, Kite/Gilead, Merck Sharp & Dohme, and Takeda, outside the submitted work. PS has received personal fees from Gilead and Novartis, outside the submitted work. VM has received personal fees from Gilead, outside the submitted work. MD has received personal fees from Gilead-Kite and Astellas, and grants and personal fees from Merck Sharp & Dohme, outside the submitted work. SV has received non-financial support from Pfizer and personal fees from Gilead-Kite, outside the submitted work. All other authors declare no competing interests. (Copyright © 2021 Elsevier Ltd. All rights reserved.) |
| التعليقات: | Comment in: Lancet Haematol. 2021 May;8(5):e311-e312. (PMID: 33894165) |
| فهرسة مساهمة: | Investigator: L Zafrani; E Mariotte; V Lemiale; B Arnulf; N Boissel; C Thieblemont; F Rabian; S Harel; R Di Blasi; J Delgado; V Ortiz; D Blaise; S Fürst; F Legrand; C Chabannon; E Forcade; FX Gros; C Borel; A Huynh; C Récher; J Rudzki; K Rakszawski; P Sesques; E Bachy; G Salles; MA Perales; P Wohlfarth; T Staudingert; U Jäger; G Cartron; N Fégueux; P Ceballos; L Platon; T Gastinne; B Tessoulin; A Le Bourgeois; O Gavrilina; A Sureda; A Mussetti; JG Borrega; P Borchmann; Y Lin; R Benjamin; S de Guibert; Q Quelven; I Yakoub-Agha; D Beauvais; MT Rubio |
| تواريخ الأحداث: | Date Created: 20210424 Date Completed: 20210503 Latest Revision: 20210503 |
| رمز التحديث: | 20231215 |
| DOI: | 10.1016/S2352-3026(21)00060-0 |
| PMID: | 33894170 |
| قاعدة البيانات: | MEDLINE |
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