Chimeric antigen receptor (CAR)-T cell therapy improves the quality of life of cancer patients, a new US study has shown. However, a significant minority of patients continue to experience psychological and physical symptoms six months after CAR-T infusion.
Research published in Blood Advances yesterday showed on average, patients with blood cancers experienced a significant improvement in their reported quality of life six months after receiving the treatment.
Lead study author Dr Connor Johnson, an oncologist at Massachusetts General Hospital, USA, said: “CAR-T has revolutionised the treatment of patients with relapsed and refractory blood cancers.
“But it remains a unique treatment with unique toxicities, including cytokine release syndrome, which is an inflammatory flu-like ailment, as well as neurologic toxicities. And these complications can take a toll on patients.
“Given the relatively new development of CAR-T therapy, there are a limited set of studies that have examined patient reported outcomes in those receiving these treatments.”
For this study, the team enrolled 103 patients, aged 23-90, all of whom had received a blood cancer diagnosis between April 2019 and November 2021.
Of these patients, 71% were diagnosed with lymphoma, 28% with myeloma, and 1% with B-cell acute lymphoblastic leukaemia. Those eligible for CAR-T therapy most commonly received tisagenlecleucel (34%), lisocabtagene maraleucel (16%), axicabtagene ciloleucel (13%), and idecabtaene vicleucel (12%).
The researchers used several self-reported questionnaires at various time points: prior to CAR-T cell infusion, one week, one month, three months, and six months afterwards.
Quality of life was measured using the Functional Assessment of Cancer Therapy-General (FACT-G). Psychological distress was measured using the Hospital Anxiety and Depression Scale (HADS), Patient Health Questionnaire-9 (PHQ-9), and the Post-Traumatic Stress Checklist (PCL).
The team also used the Edmonton Symptom Assessment System (ESAS-r) to record physical symptom burden.
Overall, 76% of patients achieved remission and 33% experienced immune effector cell-associated neurotoxicity syndrome. However, 38% of patients did not survive the length of follow up for the study.
When analysing how CAR T-cell therapy affected patient quality of life, the team established that for most participants, quality of life initially declined in the first week after the therapy, decreasing from a median baseline of 77.9 to 70.1.
However, they significantly increased, to a median of 83.7, by the six-month mark post infusion. There were also improvements in the physical symptom burden, as well as anxiety symptoms.
Most reported experiencing an improvement in their quality of life, but about 20% said they had experienced persistent physical and psychological symptoms, which at times were detrimental to quality of life.
Dr Johnson said: “Here we show significant improvements in quality of life among patients with an array of blood cancer diagnoses, receiving a variety of CAR-T products.
“However, we also identify a distinct subset of patients who have persistent physical and psychological symptom burden, even at the six-month post CAR-T time point. And I hope that these findings lead to additional interventions with a goal of improving the overall quality of life trajectory of all patients.”
Johnson PC, Dhawale TM, Newcomb RA, Amonoo HL, Lavoie MW, Vaughn DM, Karpinski K, El-Jawahri A. (2023) “Longitudinal Patient-reported Outcomes in Patients Receiving Chimeric Antigen Receptor T-Cell Therapy.” Blood Advances, doi: 10.1182/bloodadvances.2022009117
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