ICU sedation, delirium & recovery
Features and outcomes of patients admitted to the intensive care unit (ICU) for chimeric antigen receptor T cell-related toxicity: a French multicentre cohort
Authors' conclusion
ICU admission is common after CAR-T therapy and is usually performed to manage specific toxicities. Our experience is encouraging, with low ICU mortality despite a high rate of grade 3-4 toxicities, and half of patients being alive and in complete remission at one year.
Study context
- Population
- Adults admitted to either of two French ICUs in 2018–2022 within 3 months after CAR-T therapy for refractory haematological malignanciesof 238 given CAR-T
- Participants
- 84 adults
- Outcome
- Clinical features and outcomes of ICU-admitted patients after CAR-T therapy
Methodological detailsobservational, multicentre (two French ICUs), consecutive adults
- Observational
- Multicentre (two French ICUs)
- Consecutive adults
Main finding
As reported in the abstract
Clinical features and outcomes
- ICU admission among patients given CAR-T
- 84 (35.3%)
- Time from CAR-T infusion to ICU admission, median [range] days
- 5 [0-7]
- SOFA score, median
- 3 [2-6]
- SAPSII score, median
- 39 [30-48]
- Cytokine release syndrome
- 80/84 (95.2%)
- Cytokine release syndrome grade 3-4
- 18/80 (22.5%)
- ICANS
- 46/84 (54.8%)
- ICANS grade 3-4
- 29/46 (63%)
- Haemophagocytic lymphohistiocytosis
- 15/84 (17.9%)
- Tocilizumab use
- 73/84 (86.9%)
- Tocilizumab doses, median
- 2 [1-4]
- Steroids
- 55/84 (65.5%)
- High-dose pulse steroids
- 21/55 (38.2%)
- Vasopressors
- 23/84 (27.4%)
- Invasive mechanical ventilation
- 12/84 (14.3%)
- Dialysis
- 4/84 (4.8%)
- ICU deaths (incl. 2 after ICU readmission)
- 4.8%
Observational data: associations, not effects.
Further findings
Status 1 year after CAR-T therapy
- Alive and in complete remission
- 41/84 (48.9%)
- Alive and in relapse
- 14/84 (16.7%)
- Died
- 29/84 (34.5%)
- Outcomes similar to patients never admitted to the ICU
Safety
- Bacterial infections
- 23/84 (27.4%)
- Fungal infections (1 invasive pulmonary aspergillosis, 2 Mucorales)
- 3/84 (3.6%)
- Cytomegalovirus infection
- 2 (2.4%)
Original publication
Features and outcomes of patients admitted to the ICU for chimeric antigen receptor T cell-related toxicity: a French multicentre cohort. Ann Intensive Care. Published 31 January 2024. doi:10.
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