R/R LBCL 患者 CAR-T 细胞治疗出院后 30 天与 90 天内医疗资源使用增加的相关因素

Background/Objectives : CAR T-cell therapy is a highly efficacious therapy option for relapsed/refractory (R/R) large B-cell lymphoma (LBCL), but its widespread use is currently limited by safety concerns and high healthcare costs. Methods : We evaluated 66 patients with R/R LBCL treated with tisagenlecleucel or axicabtagene ciloleucel between 2016 and 2022 at a single institution to identify factors associated with increased healthcare utilization. Results : The median age of our cohort was 59. 5 years, with 22. 7% over the age of 70. The median length of stay (LOS) during the initial hospitalization was 12 days (range, 7-62 days). Longer initial hospital LOS was linked to higher age-adjusted HCT-CI score (IRR 1. 08; 95% CI, 1. 01 to 1. 15; p = 0. 0203), thrombocytopenia grade 3-4 (IRR 1. 32; 95% CI, 1. 07 to 1. 63; p = 0. 0091), and first ICU admission (IRR 1. 81; 95% CI, 1. 37 to 2. 38; p < 0. 00001). Thirty- and 90-day readmission rates post-discharge after receiving CAR T-cell therapy were 21.

2% and 28. 8%, respectively. Multiple readmissions within 90 days after initial hospital discharge were observed in 15% of patients. Longer 30-day readmission LOS was linked to initial hospital LOS (IRR 1. 23; 95% CI, 1. 11 to 1. 35; p < 0. 0001) but outpatient follow-up was associated with shorter 30-day readmission LOS (IRR 0. 43; 95% CI, 0. 26-0. 69; p = 0. 0005). Factors associated with longer 90-day readmission LOS included a greater number of ER visits within 60 days of CAR T-cell therapy (IRR 3.

10; 95% CI, 2. 15-4. 46), prior 30-day readmission LOS (IRR 1. 35; 95% CI, 1. 14-1. 60), and SUVmax at Day 30 (IRR 1. 06; 95% CI, 1. 03-1. 09) (all p -values < 0. 0001). Conclusions : Our findings identify key clinical and utilization variables associated with initial and repeat hospitalizations post-CAR T-cell therapy, emphasizing the need for targeted interventions to reduce readmissions and optimize post-discharge care.