(P-BT-20) Longitudinal Analysis Reveals Increasing CAR-T Collections and Decreasing Autologous HSCT Collections in A Tertiary Care Apheresis Facility Over a Six-Year Period.

Sunday, October 20, 2024

12:00 PM - 1:00 PM

Presenting Author(s)

AP

Aswath P. Padmanabhan Chandrasekar, MBBS

Mayo Clinic, Minnesota, United States

Background/Case Studies: Since the first approval of Chimeric Antigen Receptor T-cell (CAR-T) therapies in 2017, they have experienced widespread clinical adoption. Evolving clinical trends have recently been described with increasing CAR-T infusions occurring in conjunction with decreasing hematopoietic stem cell (HSCT) infusions. As both products are collected by apheresis, we evaluated trends in CAR-T and autologous HSCT collections over a six-year period.

Study

Design/Methods: The apheresis patient database was reviewed to compile a list of patients that underwent either CAR-T or HSCT (autologous) collections, between 01/01/2018 and 12/12/2023. The number of individual HSCTs and CAR-T collections, and percent contribution to the total number of patients collected per year were plotted over time. Simple linear regression was used to calculate directionality of change and statistical significance to determine if the slopes were non-zero.

Results/Findings: Our study included 585 collection procedures for CAR-T manufacture and 5249 HSCT collections, for 551 and 2271 patients respectively. Between 2018 and 2023, the number of individual collection procedures for CAR-T increased significantly (p=0.0016) and autologous HSCT decreased (p=0.09), while there was no change in the overall number of collections (p=0.41). The mean number of collections per patient was 1.06 for CAR-T versus 2.31 for HSCT (p< 0.0001).
The total number of patients undergoing CAR-T collections increased significantly over the six-year period, from 52 in 2018 to 150 in 2023 (p=0.0013), accompanied by a significant decrease in the number of patients collecting for HSCT, from 425 in 2018 to 341 in 2023 (p=0.0177). The overall number of patients undergoing collection (calculated as number of HSCT + number of CAR-T) did not change significantly (mean 476 + 20.4 per year; p=0.64). When expressed as a percentage of the total, we observed a significant increase in the proportion of CAR-T, from 11.5% in 2018 to 32.1 % in 2023, (p=0.0016), and a significant decrease in the proportion of HSCT, from 88.5% in 2018 to 67.9% in 2023 (p=0.0016). The number of patients collecting HSCT decreased significantly for both myeloma (p=0.048) and lymphoma (p=0.038) group disorders, while HSCT collections decreased significantly for the lymphoma (p=0.002) group with no change for myeloma group disorders (p=0.64). Other indications remained stable.

Conclusions:

Our study provides valuable insights for apheresis facilities when considering resource allocation and infrastructure development. Our findings highlight a significant shift in the apheresis referral practice, with more patients undergoing CAR-T collection and fewer autologous HSCT. Despite the shift, the overall number of collections and patients collected was relatively stable. Resource utilization in the apheresis unit will remain high regardless of the type of product utilized by the clinical services.