Outcomes of Outpatient CD19-Targeted Chimeric Antigen Receptor T-Cell Therapy in Relapsed or Refractory B-Cell Lymphomas: A Systematic Review and Meta-Analysis

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Background The recent interest in outpatient Chimeric Antigen Receptor (CAR)T-cell infusion, which aims to reduce healthcare costs and eliminate the need for extended hospital stays, presents a promising future for B-cell lymphoma treatment. This study investigated outcomes after outpatient CD19-targeted CAR T-cell therapy in patients with relapsed or refractory B-cell lymphomas. Methods A comprehensive literature search was performed on PubMed, Cochrane, and Clinicaltrials.gov using relevant MeSH terms and keywords. Six original studies reporting outcomes in outpatient CAR T-cell therapy were included. Data analysis was done using R version 4.4.0 with "meta" and "metasens" packages, utilizing a random-effects model. Heterogeneity was assessed with I², and 95% confidence intervals (CI) were calculated. Results A total of 290 patients from 6 studies who received axi-cel (axicabtagene ciloleucel), tisa-cel (tisagenlecleucel), liso-cel (lisocabtagene maraleucel), and brexu-cel (brexucabtagene autoleucel), and reporting outcomes for relapsed and refractory B-cell lymphomas as outpatients were included. The most common indication for CAR T-cell therapy was diffuse large B-cell lymphoma in 69.3% (n=138/199), followed by follicular lymphoma in 14.5% (n=29/199) and mantle cell lymphoma in 10.5% (n=21/199) of patients. Two out of six studies reported using fludarabine and cyclophosphamide as lymphodepletion and a median of 3.5 (1-6) therapies prior to CAR T-cell therapy. Within 30 days of CAR T-cell infusion, 71.2% (114/163) of patients required hospitalization, and 5.4% (5/91) required ICU admission. The median length of hospitalization was six days (5-14), and the median time from CAR T-cell therapy to hospitalization was four days (range 3-5). Cytokine release syndrome and neurotoxicity were reported in 32.7% (90/290) and 15.8% (38/239) of patients, respectively. To manage adverse effects, 12.8% (34/265) received tocilizumab, 4.5% (12/265) received steroids, and 3.7% (10/265) received both. Overall mortality was 15.6% (25/160), and the most common cause of mortality was disease progression or relapse. The pooled overall response rate (ORR), complete response (CR), and partial response (PR) were 72% (95% CI 0.00-1.00, I2=45%, p=0.18, n=49), 50% (95% CI 0.11-0.88, I2 =53%, p=0.12, n=45), and 10% (95% CI 0.00-1.00, I2 =88%, p<0.01, n=4), respectively. Conclusion Outcomes comparable to previously published studies with inpatient CAR T-cell therapy were observed with outpatient administration of CAR T-cell therapy. Outpatient CAR T-cell therapy is feasible and safe and may reduce the healthcare burden of CD19-targeted CAR T-cell therapies for B-cell malignancies. Future studies are needed to validate these findings and compare outcomes after inpatient versus outpatient infusion of CAR T-cell therapy.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.