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A Physical Therapy Screening Tool Utilizing the 6-Minute Walk Test Predicts Health Services Outcomes in Adult CAR-T Recipients.

Year: 2025

Type: article

Abstract: Introduction Chimeric antigen receptor T-cell therapy (CAR-T) has revolutionized the treatment of patients (pts) with lymphoproliferative disorders , which primarily affect older adults (age≥60 years). We have previously demonstrated these pts often show a high burden of geriatric syndromes , including impaired physical function, at the time of CAR-T evaluation. Impaired physical function, as defined by the 6-minute walk test (6MW), gait speed (GS), and 5-times sit-to-stand (5xSTS), is likely reflective of a combination of the age-related muscle decline starting in the fourth decade of life, cancer-related cachexia at diagnosis and longitudinally during a patient's treatment, and myocyte toxicity related to chemotherapy and glucocorticoid therapy commonly utilized in the treatment of these diseases. In this study, we explored the utility of 6MW, GS, and 5xSTS at the time of admission for CAR-T treatment to identify those pts most at risk for poor outcomes at hospital discharge. Methods All pts age ≥18 years admitted for CAR-T at our institution from 7/2019-6/2024 were screened for impaired physical function by a physical therapist utilizing 6MW (<400 meters), GS (<1.0 meters/second), and 5xSTS (<11.19 seconds) in line with previously validated cut points for these measures. The primary outcome was hospital length of stay (LOS), with days in the hospital being the outcome assessed by linear regression modeling. Key covariates, performance status, disease severity (LDH and ferritin), and CAR-T comorbidity score (Severe4), were included in the multivariable analysis. Severe4 (Shouse, Blood Advances, 2023) was scored 0-4 (high risk: Severe4≥1) by presence of severe comorbidity in the respiratory, upper gastrointestinal, hepatic, and renal systems . Results 127 pts were evaluated using the screening tool with a median age of 67.3 years (range, 20.6-83.4 years),79% were age≥60 years, 65% male, and 72% Caucasian. Multiple myeloma (45%) and diffuse large B-cell lymphoma (26%) were the most common diagnoses. Ciltacabtagene autoleucel (24%) and tisagenlecleucel (18%) were the most common CAR-T products. The cohort was heavily pre-treated (70% with ≥3 prior lines of therapy) and 41% received bridging therapy. Despite 96% having ECOG≤1 and 91% assessed as Severe4=0, impaired 6MW, GS, and 5xSTS testing were identified in 72%, 56%, and 68% of pts, respectively. Median LOS was 16.0 days (range, 7-80 days). In both the entire cohort and in the older adult subgroup (age≥60 years), each 100 meters of shorter 6MW distance predicted an increase in LOS of 3 days when controlling for performance status, Severe4, and disease severity at CAR-T admission (Figure 1). Discussion Utilizing a validated, simple physical therapy screening tool of 6MW at admission may permit identification of CAR-T pts at risk for prolonged LOS and may guide future physical activity interventions with the goal of decreasing LOS.

Source: Transplantation and Cellular Therapy

DOI: 10.1016/j.jtct.2025.01.674