P033 | Low Mortality in Intensive Care Unit Following Car-t Cell Therapy: Insights From a Monocentric Real-world Experience
Year: 2025
Type: article
Abstract: Background Chimeric Antigen Receptor T-cell (CAR-T) therapy has become a highly effective treatment for patients with refractory hematological malignancies. Despite frequent adverse events that are typically reversible, up to 30% of patients require ICU admission, with reported ICU mortality rates ranging from 27% to 35%1. This study aimed to evaluate mortality rate and outcomes in patients admitted in ICU. Methods We performed a retrospective, single-center analysis of 146 adult patients who underwent CAR-T therapy at Humanitas Research Hospital between November 2019 and December 2024. Management of CRS and ICANS followed institutional guidelines2. Results CRS occurred in 125 patients (86%), with 6 patients (4%) experiencing grade 3 CRS; no grade 4 CRS events were observed. ICANS was documented in 41 patients (28%), with 17 patients (11%) developing grade ≥3 ICANS. Twenty-five patients (17%) required ICU care (median ICU stay: 2.5 nights). The main reasons for ICU admission were ICANS (68%), CRS (20%), infections (4%), and progressive disease (8%). The infection rate among ICU patients was 28%. ICU interventions included vasoactive support (6 patients), oxygen therapy (16 patients: 6 with high-flow nasal cannula, 10 with conventional oxygen therapy, and 2 with non-invasive ventilation), intubation in 7 patients (mainly for grade 4 ICANS), and tracheostomy in 2 patients due to prolonged mechanical ventilation. Three patients required ICU readmission for grade 4 ICANS, septic shock, and acute respiratory failure from platypnea-orthodeoxia syndrome. The early mortality rate (<30 days post-CAR-T) was 2%, with two deaths from infections and one from grade 4 ICANS. Only one patient died in the ICU, resulting in an ICU mortality rate of 4%. After a median follow-up of 9.4 months, the 1-year overall survival (OS) rate was 71.4%, with no significant difference between ICU (65.2%) and non-ICU patients (75.6%) (p=0.66). The 1-year progression-free survival (PFS) rate was 54.5%, with rates of 50.3% in ICU and 58.2% in non-ICU patients (p=0.60). Conclusions In this single-center study, the ICU mortality rate following CAR-T therapy was lower than previously reported. Long-term outcomes, including OS and PFS, were similar between ICU and non-ICU patients, suggesting that optimized patient selection, early toxicity management, and close ICU collaboration may reduce severe complications. ICANS emerged as the leading cause of ICU admission, unlike earlier studies.
Authors: A. Giacomel, R. Lungu, C. De Philippis, D. Taurino, D. Mannina, J. Mariotti, B. Sarina, A. Santoro, E. Costantini
Language: English
Topic: CAR-T cell therapy research
Subfield: Oncology
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W7093123609
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