Comparative Study Evaluating Hospitalizations and Critical Care Stays among Patients with R/R Large B-Cell Lymphoma (LBCL) Treated with CAR T Cell Therapies Lisocabtagene Maraleucel (Liso-Cel) and Axicabtagene Ciloleucel (Axi-Cel) in the Inpatient (IP) and Outpatient (OP) Setting Using United States (US) Claims Data

BackgroundDue to the growing use of CAR T cell therapies in R/R LBCL, it is crucial to understand their economic burden for the treatment of adult patients with R/R LBCL, including DLBCL in the real-world setting. This retrospective study was conducted to evaluate IP procedures and critical care admissions of patients with R/R LBCL infused with liso-cel or axi-cel in the IP and OP setting.MethodsWe evaluated adult patients with R/R LBCL using a large US claims database, Symphony Health's Integrated Dataverse (01/01/2017–05/04/2023), with a confirmed LBCL diagnosis and ≥ 1 liso-cel or axi-cel claim. The index date was defined as the first claim of CAR T cell infusion and the baseline period was defined as the 3 months before the index date. Patients were required to have ≥ 3 months of clinical activity before and after the index date and were excluded if they had a confirmed diagnosis for a metastatic solid tumor before the index date. Study outcomes included IP procedures within 30 days of infusion and admissions into critical care. To allow for 7 days of monitoring after infusion, IP procedures between 8 and 30 days after infusion were analyzed. Outcomes were compared between patients treated with liso-cel and axi-cel with multivariate regression models adjusting for age, Quan Charlson Comorbidity Index (Quan-CCI), and infusion setting (IP/OP).ResultsOf 553 patients meeting the eligibility criteria, 103 received liso-cel and 450 received axi-cel. The mean age of patients treated with liso-cel and axi-cel were 69 and 61 years, respectively, and Quan-CCI scores were 3.6 and 3.3, respectively. Forty-four percent of patients treated with liso-cel and 10% treated with axi-cel received infusion in the OP setting. After adjusting for age, Quan-CCI, and infusion setting, the adjusted risk of IP procedures was 64% lower within 30 days after infusion (P < 0.001; Figure) for patients treated with liso-cel compared with axi-cel. Furthermore, accounting for the monitoring period after infusion, the risk of IP procedures between 8 and 30 days after infusion was 73% lower (P = 0.001) with liso-cel compared with axi-cel. The risk of critical care admission after infusion was 56% lower with liso-cel compared with axi-cel (P = 0.037).ConclusionsIn using a large US claims database, this study found that patients with R/R LBCL who were treated with liso-cel were 4 times more likely than those treated with axi-cel to be infused in the OP setting. Liso-cel had a statistically significant lower burden of IP procedures and critical care admissions compared with axi-cel. After adjusting for baseline variables, patients treated with liso-cel had reduced risk of IP procedures in the 30 days after infusion and critical care admission compared with axi-cel.