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Hoogland AI, Li X, Modi K, Welniak T, Rodriguez Y, Irizarry-Arroyo N, Oswald LB, Snider JT, Wade SW, Chavez J, Corallo S, Booth-Jones M, Jain MD, Locke FL, Jim HSL. Real-World Patient-Reported and Neurocognitive Outcomes in the Year After Axicabtagene Ciloleucel. Transplant Cell Ther 2024:S2666-6367(24)00839-X. [PMID: 39733840 DOI: 10.1016/j.jtct.2024.12.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2024] [Revised: 12/13/2024] [Accepted: 12/24/2024] [Indexed: 12/31/2024]
Abstract
Axicabtagene ciloleucel (axi-cel), a chimeric antigen receptor T-cell therapy, has significantly improved clinical outcomes in adult patients with relapsed/refractory large B-cell lymphoma. However, few studies have examined patient-reported outcomes (PROs) or neurocognitive performance in patients treated with axi-cel. Moreover, no longitudinal PRO study has reported on patients treated with axi-cel as standard of care in the United States, to our knowledge. This paper reports on real-world changes in PROs (i.e., quality of life [QOL] and perceived cognition) and objective neurocognitive performance before treatment with axi-cel and in the first year after. Patients scheduled to receive axi-cel as standard of care were recruited from a single cancer center between March 2020 and June 2022. QOL was assessed using the EORTC QLQ-C30 and EQ-5D-5L at baseline recruitment (ie, prior to conditioning chemotherapy before axi-cel), and at 7, 14, 30, 60, 90, 180, and 360 days after receiving axi-cel. Perceived cognition was assessed using the Patient-Reported Outcomes Measurement Information System Cognitive Function 4a scale. Objective neurocognitive performance was assessed using a battery of tests at baseline, and 30, 90, and 360 days after receiving axi-cel. Random-effects mixed models evaluated changes in QOL, perceived cognition, and neurocognitive performance using all available data. Clinically meaningful change in QOL was defined as a difference of 10 points on the EORTC QLQ-C30. Clinically meaningful change in perceived cognition or neurocognitive performance was defined as a difference of 5 points. On average, participants (N = 53) were 63 years of age (SD = 13), and predominantly male (62%), White (92%), and college graduates (60%). Participants reported statistically significant improvements from baseline to day 360 in overall QOL, physical functioning, role functioning, and social functioning (Ps < .05) after axi-cel, despite clinically significant worsening in the first 14 days. For role functioning and social functioning, improvements also met criteria for clinical significance. There were no statistically (Ps > .05) or clinically significant changes in perceived cognition over time. Despite some transient declines, neurocognitive performance generally returned to or exceeded baseline levels by day 360 (Ps < .01). However, visuospatial ability worsened by day 90 and did not recover to baseline levels by day 360 (P < .0001). These real-world data suggest that axi-cel is associated with significant improvements in overall QOL in the first year after infusion. These data are generally consistent with, or exceed, improvements in QOL reported from clinical trials of axi-cel therapy. Despite transient worsening in the acute period after treatment, neurocognitive performance in most domains also recovered to pretreatment levels by 1 year after infusion. These findings extend previous research by reporting on patients' perspectives on axi-cel therapy received as standard of care in the real-world setting and neurocognitive changes after treatment with axi-cel.
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Hoogland AI, Barata A, Li X, Irizarry-Arroyo N, Jain MD, Welniak T, Rodriguez Y, Oswald LB, Gudenkauf LM, Chavez JC, Khimani F, Lazaryan A, Liu HD, Nishihori T, Pinilla-Ibarz J, Shah BD, Crowder SL, Parker NH, Carson TL, Vinci CE, Pidala JA, Logue J, Locke FL, Jim HSL. Prospective Assessment of Quality of Life and Patient-Reported Toxicities Over the First Year After Chimeric Antigen Receptor T-Cell Therapy. Transplant Cell Ther 2024; 30:1219.e1-1219.e11. [PMID: 39306278 PMCID: PMC11635818 DOI: 10.1016/j.jtct.2024.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Revised: 09/05/2024] [Accepted: 09/14/2024] [Indexed: 09/26/2024]
Abstract
Chimeric antigen receptor (CAR) T-cell therapy has transformed survival outcomes in patients with relapsed and refractory large B-cell lymphoma (LBCL), but it is associated with a variety of side effects. This study examined changes in patient-reported quality of life (QoL) and toxicities, as well as risk factors for worse QoL and toxicities, in the first year after treatment. Patients with LBCL completed questionnaires assessing QoL and toxicity severity before infusion, and 90, 180, and 360 days after infusion. Mixed models were used to examine changes in QoL and toxicities over time, and clinical moderators of change in QoL and toxicities. Patients reported improvements in physical functioning and fatigue in the year after treatment (P values <.01), but there were no changes in pain, anxiety, or depression over time. Patients with active disease at day 90 reported more physical dysfunction at all postinfusion timepoints (Ps ≤ .01) compared to patients who responded to treatment. Similarly, patients with active disease at day 90 reported worsening depression over time, such that at day 360, depressive symptoms were worse for patients with active disease than patients without active disease (P = .02). Patients treated with 4+ lines of prior therapy reported worsening pain and anxiety over time, such that at day 360, both pain and anxiety were significantly worse for patients previously treated with 4 of more lines of therapy than patients treated with fewer lines of therapy (Ps ≤ .01). Regarding toxicities, patients reported decreasing overall toxicity burden up to day 180, with subsequent worsening at day 360 (P = .02). Most patients reported at least one or two grade 2 toxicities at each timepoint. Patients demonstrated unchanging or improved QoL after treatment with CAR T-cell therapy, but active disease and greater prior lines of therapy were associated with worse QoL outcomes over time. Toxicity severity also improved during the first 6 months post-treatment, but worsened thereafter, particularly among patients with active disease after treatment.
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Kirtane K, Reblin M, Oswald LB, Irizarry-Arroyo N, McCormick R, Locke FL, Ketcher D. Psychosocial characteristics of patients undergoing cellular immunotherapies and their caregivers across time. Leuk Lymphoma 2023; 64:364-370. [PMID: 36416677 DOI: 10.1080/10428194.2022.2148216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Chimeric antigen receptor T-cells and other immunotherapies have markedly changed the paradigm of treatment for patients with relapsed or refractory hematologic malignancies. While notable in efficacy, immunotherapy is characterized by a significant possibility of life-threatening side effects. Consequently, patients are often required to have informal family caregivers present and to stay near the treating center for several weeks after cell infusion. Further, the responsibility of managing a great deal of physical care and emotional support falls to these caregivers. Given the novelty of immunotherapy treatment, there is a need to better understand the psychosocial experience of patients receiving this treatment and their caregivers. This article describes the psychosocial characteristics of patients undergoing cellular immunotherapies and their caregivers across time, including patient/caregiver distress, coping, and caregiver burden and preparedness.
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Oswald LB, Li X, Carvajal R, Hoogland AI, Gudenkauf LM, Hansen DK, Alsina M, Locke FL, Rodriguez Y, Irizarry-Arroyo N, Robinson EJ, Jim HSL, Gonzalez BD, Kirtane K. Longitudinal Collection of Patient-Reported Outcomes and Activity Data during CAR-T Therapy: Feasibility, Acceptability, and Data Visualization. Cancers (Basel) 2022; 14:cancers14112742. [PMID: 35681722 PMCID: PMC9179384 DOI: 10.3390/cancers14112742] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 05/23/2022] [Accepted: 05/30/2022] [Indexed: 01/27/2023] Open
Abstract
Background: Clinicians must closely monitor patients for toxicities after chimeric antigen receptor T-cell therapy (CAR-T). Patient-reported outcomes (PROs) (e.g., toxicities, quality of life) and activity data (e.g., steps, sleep) may complement clinicians’ observations. This study tested the feasibility and acceptability of collecting PROs and activity data from patients with hematologic malignancies during CAR-T and explored preliminary data patterns. Methods: Participants wore a Fitbit tracker and completed PROs at several timepoints through 90-days post-infusion. Feasibility was assessed with a priori benchmarks for recruitment (≥50%), retention (≥70%), PRO completion (≥70%), and days wearing the Fitbit (≥50%). Acceptability was assessed with participant satisfaction (a priori benchmark > 2 on a 0−4 scale). Results: Participants (N = 12) were M = 66 years old (SD = 7). Rates of recruitment (68%), retention (83%), PRO completion (85%), and days wearing the Fitbit (85%) indicated feasibility. Satisfaction with completing the PROs (M = 3.2, SD = 0.5) and wearing the Fitbit (M = 2.9, SD = 0.5) indicated acceptability. Preliminary data patterns suggested that participants with better treatment response (vs. progressive disease) had a higher toxicity burden. Conclusions: Longitudinal PRO and activity data collection was feasible and acceptable. Data collected on a larger scale may be used to specify risk prediction models to identify predictors of severe CAR-T-related toxicities and inform early interventions.
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Kirtane K, Reblin M, Oswald L, Irizarry-Arroyo N, Gonzalez B, Locke FL, Ketcher D. Lived Experience and Intervention Considerations for Caregivers of Patients Who Receive Cellular Immunotherapy: A Qualitative Study. Transplant Cell Ther 2022. [DOI: 10.1016/s2666-6367(22)00659-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Barata A, Hoogland AI, Hyland KA, Otto AK, Kommalapati A, Jayani RV, Irizarry-Arroyo N, Collier A, Rodriguez Y, Welniak TL, Booth-Jones M, Logue J, Small BJ, Jain MD, Reblin M, Locke FL, Jim HSL. Quality of life in caregivers of patients receiving chimeric antigen receptor T-cell therapy. Psychooncology 2021; 30:1294-1301. [PMID: 33739548 PMCID: PMC9828891 DOI: 10.1002/pon.5674] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 03/06/2021] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Informal family caregivers provide critical support for patients receiving chimeric antigen receptor (CAR) T-cell therapy. However, caregivers' experiences are largely unstudied. This study examined quality of life (QOL; physical functioning, pain, fatigue, anxiety, and depression), caregiving burden, and treatment-related distress in caregivers in the first 6 months after CAR T-cell therapy, when caregivers were expected to be most involved in providing care. Relationships between patients' clinical course and caregiver outcomes were also explored. METHODS Caregivers completed measures examining QOL and burden before patients' CAR T-cell therapy and at days 90 and 180. Treatment-related distress was assessed at days 90 and 180. Patients' clinical variables were extracted from medical charts. Change in outcomes was assessed using means and 99% confidence intervals. Association of change in outcomes with patient clinical variables was assessed with backward elimination analysis. RESULTS A total of 99 caregivers (mean age 59, 73% female) provided data. Regarding QOL, pain was significantly higher than population norms at baseline but improved by day 180 (p < .01). Conversely, anxiety worsened over time (p < .01). Caregiver burden and treatment-related distress did not change over time. Worsening caregiver depression by day 180 was associated with lower patient baseline performance status (p < .01). Worse caregiver treatment-related distress at day 180 was associated with lower performance status, intensive care unit admission, and lack of disease response at day 90 (ps < 0.01). CONCLUSIONS Some CAR T-cell therapy caregivers experience pain, anxiety, and burden, which may be associated patients' health status. Further research is warranted regarding the experience of CAR T-cell therapy caregivers.
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Barata A, Hoogland AI, Hyland K, Kommalapati A, Irizarry-Arroyo N, Rodriguez Y, Booth-Jones M, Jain MD, Locke FL, Jim HS. Patient-Reported Toxicities in Axicabtagene Ciloleucel Recipients: 1-Year Follow-up. Transplant Cell Ther 2021. [DOI: 10.1016/s2666-6367(21)00485-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Hoogland AI, Jayani RV, Collier A, Irizarry-Arroyo N, Rodriguez Y, Jain MD, Booth-Jones M, Hyland KA, James BW, Barata A, Bachmeier CA, Chavez JC, Khimani F, Krivenko GS, Lazaryan A, Liu HD, Nishihori T, Pinilla-Ibarz J, Shah BD, Abidi M, Locke FL, Jim HSL. Acute patient-reported outcomes in B-cell malignancies treated with axicabtagene ciloleucel. Cancer Med 2021; 10:1936-1943. [PMID: 33641257 PMCID: PMC7957158 DOI: 10.1002/cam4.3664] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 10/27/2020] [Accepted: 11/17/2020] [Indexed: 12/20/2022] Open
Abstract
Chimeric antigen receptor T‐cell therapy with axicabtagene ciloleucel (axi‐cel) has considerably improved survival in adults with relapsed/refractory large B‐cell lymphoma. This study reports patient‐reported outcomes (PROs) such as quality of life (QOL) and toxicity in the first 90 days after treatment. Hematologic cancer patients treated with axi‐cel (N = 103, mean age = 61, 39% female) completed SF‐36 or PROMIS‐29 QOL questionnaires prior to treatment and 90 days after. PRO‐Common Terminology Criteria for Adverse Events toxicity items were completed by patients at baseline and 14, 30, 60, and 90 days after treatment. Mixed models examined change in PROs over time. From preinfusion to 90 days later, patients reported improvements in physical functioning, pain, and fatigue (ps < 0.01), but worsening of anxiety (p = 0.02). Patient‐reported toxicities worsened by day 14 with improvement thereafter. The five most severe symptoms at day 14 included fatigue, decreased appetite, dry mouth, diarrhea frequency, and problems with concentration. Results indicate improvement in some domains of QOL over time with transient patient‐reported toxicities.
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James BW, Hoogland AI, Irizarry-Arroyo N, Muzaffar J, Kirtane K, Kish JA, Jim HS, Chung CH. Abstract 5751: Patient-reported toxicities in head and neck cancer patients treated with immunotherapy. Cancer Res 2020. [DOI: 10.1158/1538-7445.am2020-5751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Immune checkpoint inhibitors (ICIs) (i.e. nivolumab, pembrolizumab) are FDA-approved agents used in the treatment of various head and neck malignancies. While much is known about clinician-rated adverse clinical events of these immunotherapies from clinical trials, less is known about patient-reported toxicities. The goal of the current study was to describe patient-reported toxicities in patients receiving ICIs for head and neck cancer.
Methods: Patients with head and neck cancer were recruited as part of a larger study on quality of life on ICIs. Prior to initiation of ICIs, participants completed a sociodemographic questionnaire and a measure of symptomatic toxicities of ICIs developed based on input form providers, patients, and caregivers. Patients completed follow-up symptom assessments every 6-8 weeks until cancer progression. Severity of each symptom over the past 7 days was rated on a 5-point scale (i.e., 0 = “not at all,” 4 = “very much”). A score of 3 or 4 was considered moderate to severe symptomatology.
Results: There were 45 patients (22% female; M age = 62), who completed a least 2 symptom assessments before cancer progression. The five most common moderate to severe symptoms at baseline were fatigue (27%), changes in taste (18%), insomnia (16%), coughing (11%), and muscle aches (9%). At the assessment before cancer progression, the five most common moderate to severe symptoms were fatigue (38%), insomnia (24%), rash (13%), cough (13%), and numbness in hands and feet (13%). From the baseline assessment to the last symptom assessment preceding progression, most patients reported worsening skin dryness (49%), skin sensitivity (46%), weakness in arms of legs (46%), and itching (42%). Most patients also reported worsening fatigue (49%), although a large subset reported improvements in fatigue (36%).
Conclusion: Results indicate that fatigue and insomnia are the most common and severe patient-reported toxicities of ICIs for head and neck cancer. These preliminary findings warrant larger future studies with longer follow-up to better understand changes in patient-reported toxicities in this population.
Citation Format: Brian W. James, Aasha I. Hoogland, Nathaly Irizarry-Arroyo, Jameel Muzaffar, Kedar Kirtane, Julie A. Kish, Heather S. Jim, Christine H. Chung. Patient-reported toxicities in head and neck cancer patients treated with immunotherapy [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 5751.
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