Abstract

Background: Chimeric antigen receptor T-cell (CAR-T) therapy targeting CD-19 utilizes ex-vivo engineered T-cells to treat refractory malignancies. Widespread CAR-T adoption is limited by resource utilization and cost, and CAR-T has also been associated with adverse cardiovascular events. Limited data exist exploring the relationship between CAR-T-associated cardiovascular events and resource utilization events (RUE). Objective: To evaluate whether CAR-T-associated cardiovascular events are associated with RUE. Methods: Records of patients treated with an FDA-approved CAR-T product between 2018 and 2022 at a single institution were reviewed. Cardiovascular events post-CAR-T were defined as arrhythmia, acute coronary syndrome, stroke, cardiovascular death, new cardiomyopathy, heart failure, or pericarditis. RUE was a composite of intensive care unit (ICU) transfer, prolonged length of stay (LOS; >75th cohort percentile), and unplanned 6-month readmission. Results: Of 117 patients, 30 (26%) experienced cardiovascular events over a median 16 (IQR 7-34) months follow-up. RUE occurred in 65 patients (56%): 28 (24%) ICU transfers, 23 (20%) prolonged LOS, and 48 (41%) readmissions. Those with RUE experienced subsequent higher mortality (62% vs. 21%, p≤0.001). Among patients who experienced cardiovascular events, 24 (80%) experienced RUEs. In a Cox model, cardiovascular events (HR 2.3, 95% CI 1.3-4.1) and high cancer burden (HR 2.1, 95% CI 1.3-3.5) were independently associated with increased RUE rate, after adjusting for age, Cytokine Release Syndrome grade ≥2, atrial fibrillation history, and CAR-T costimulatory domain. Conclusion: CAR-T recipients who experience cardiovascular events also experience increased resource utilization events. Further prospective studies are needed to assess whether post-CAR-T cardiovascular event management and/or pre-therapy assessment may reduce resource utilization burden.