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The use of ICU resources in CAR-T cell recipients: a hospital-wide study.
Valade, Sandrine; Darmon, Michael; Zafrani, Lara; Mariotte, Eric; Lemiale, Virginie; Bredin, Swann; Dumas, Guillaume; Boissel, Nicolas; Rabian, Florence; Baruchel, André; Madelaine, Isabelle; Larghero, Jérôme; Brignier, Anne; Lengliné, Etienne; Harel, Stéphanie; Arnulf, Bertrand; Di Blasi, Roberta; Thieblemont, Catherine; Azoulay, Elie.
Afiliação
  • Valade S; AP-HP, Hôpital Saint-Louis, Medical ICU, 1 avenue Claude Vellefaux, 75010, Paris, France. sandrine.valade@aphp.fr.
  • Darmon M; Université de Paris, Paris, France. sandrine.valade@aphp.fr.
  • Zafrani L; AP-HP, Hôpital Saint-Louis, Medical ICU, 1 avenue Claude Vellefaux, 75010, Paris, France.
  • Mariotte E; Université de Paris, Paris, France.
  • Lemiale V; AP-HP, Hôpital Saint-Louis, Medical ICU, 1 avenue Claude Vellefaux, 75010, Paris, France.
  • Bredin S; Université de Paris, Paris, France.
  • Dumas G; AP-HP, Hôpital Saint-Louis, Medical ICU, 1 avenue Claude Vellefaux, 75010, Paris, France.
  • Boissel N; Université de Paris, Paris, France.
  • Rabian F; AP-HP, Hôpital Saint-Louis, Medical ICU, 1 avenue Claude Vellefaux, 75010, Paris, France.
  • Baruchel A; Université de Paris, Paris, France.
  • Madelaine I; AP-HP, Hôpital Saint-Louis, Medical ICU, 1 avenue Claude Vellefaux, 75010, Paris, France.
  • Larghero J; Université de Paris, Paris, France.
  • Brignier A; AP-HP, Hôpital Saint-Louis, Medical ICU, 1 avenue Claude Vellefaux, 75010, Paris, France.
  • Lengliné E; Université de Paris, Paris, France.
  • Harel S; Université de Paris, Paris, France.
  • Arnulf B; AP-HP, Hôpital Saint-Louis, Hematology Adolescent and Young Adults Unit, URP-3518, Paris, France.
  • Di Blasi R; Université de Paris, Paris, France.
  • Thieblemont C; AP-HP, Hôpital Saint-Louis, Hematology Adolescent and Young Adults Unit, URP-3518, Paris, France.
  • Azoulay E; Department of Pediatric Hematology, AP-HP, Robert Debré Hospital, Paris, France.
Ann Intensive Care ; 12(1): 75, 2022 Aug 17.
Article em En | MEDLINE | ID: mdl-35976532
BACKGROUND: CAR-T cell (chimeric antigen receptor T) therapy has emerged as an effective treatment of refractory hematological malignancies. Intensive care management is intrinsic to CAR-T cell therapy. We aim to describe and to assess outcomes in critically ill CAR-T cell recipients. STUDY DESIGN AND METHODS: Hospital-wide retrospective study. Consecutive CAR-T cell recipients requiring ICU admission from July 2017 and December 2020 were included. RESULTS: 71 patients (median age 60 years [37-68]) were admitted to the ICU 6 days [4-7] after CAR-T cell infusion. Underlying malignancies included diffuse large B cell lymphoma (n = 53, 75%), acute lymphoblastic leukemia (17 patients, 24%) and multiple myeloma (n = 1, 1.45%). Performance status (PS) was 1 [1-2]. Shock was the main reason for ICU admission (n = 40, 48%). Isolated cytokine release syndrome (CRS) was the most common complication (n = 33, 46%), while 21 patients (30%) had microbiologically documented bacterial infection (chiefly catheter-related infection). Immune effector cell-associated neurotoxicity syndrome was reported in 26 (37%) patients. At ICU admission, vasopressors were required in 18 patients (25%) and invasive mechanical ventilation in two. Overall, 49 (69%) and 40 patients (56%) received tocilizumab or steroids, respectively. Determinant of mortality were the reason for ICU admission (disease progression vs. sepsis or CRS (HR 4.02 [95%CI 1.10-14.65]), Performance status (HR 1.97/point [95%CI 1.14-3.41]) and SOFA score (HR 1.16/point [95%CI 1.01-1.33]). CONCLUSIONS: Meaningful survival could be achieved in up to half the CAR-T cell recipients. The severity of organ dysfunction is a major determinant of death, especially in patients with altered performance status or disease progression.
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Texto completo: 1 Base de dados: MEDLINE Idioma: En Ano de publicação: 2022 Tipo de documento: Article

Texto completo: 1 Base de dados: MEDLINE Idioma: En Ano de publicação: 2022 Tipo de documento: Article