Dependence and clinical fragility in hematopoietic stem cell transplant and CAR-T therapy: a retrospective study

Autologous and allogeneic hematopoietic stem cell transplantation and CAR-T cell therapy are standard treatments for patients affected by hematologic malignancies at different stages of their clinical pathway. Several adverse events accompany these therapies during patients' hospital stay, including psycho-emotional distress and various functional and social impairments.

In this monocentric study on 498 patients, various clinical and social fragility indices, registered within clinical documentation during the hospital stay, specifically at admission (within 24 h of entry) and discharge (less than 24 h prior to leaving), were retrospectively assessed with the aim of describing their trends and evaluating for differences between type of cell therapy and underlying disease.

Functional independence mean score was lower in allogeneic patients at admission (p = 0.001) and at discharge (p = 0.001), while a higher risk of falling at discharge (p = 0.001), an increased risk of clinical deterioration at admission (p = 0.001) and at discharge (p = 0.011), and increased complexity of care at both time points (p = 0.001) were observed in patients undergoing CAR-T compared to patients undergoing allogeneic or autologous HSCT procedures. Acute lymphoid leukemia patients had significantly worse mean scores at both time points for functional independence, risk of falling, clinical deterioration, care complexity, level of pain (p =  < 0.001); while acute myeloid leukemia patients had higher risk of skin pressure injuries at discharge (p = 0.036).

Our findings may contribute to improving personalized assessment strategies in the field of cell therapy, including both CAR-T therapy and stem cell transplantation. They highlight the increased risk and complexity of care, particularly in patients receiving CAR-T therapy, while emphasizing the need for tailored management approaches across different cell therapy modalities.