Associations Between Pre-Existing Autoimmunity and Chimeric Antigen Receptor T Cell Therapy Toxicity for Cancer...

Chimeric antigen receptor (CAR) T cell therapy is being investigated to treat individuals with autoimmune diseases. Data regarding the safety of CAR T cell therapy in this population are limited. We aimed to assess whether pre-existing autoimmune disease was associated with an increase in major toxicity or hospital length of stay (LOS) among patients receiving CAR T cell therapy for the treatment of hematologic cancer.

This retrospective cohort study used data from the National Inpatient Sample (2021-2022) to investigate in-hospital outcomes in adult patients receiving CAR T cell therapy. Comparisons were drawn between patients with and without pre-existing autoimmune disease. Multivariable regression models with adjustment for age, sex, race, cancer type, and comorbidities assessed associations with hospital LOS, major toxicity, and inpatient mortality.

Among 1,321 patients receiving CAR T cell therapy, 62 (4.7%) had diagnosed autoimmune disease. Patients with pre-existing autoimmunity had a significantly shorter hospital stay compared with patients without, with a mean reduction of 2.1 days (95% confidence interval [CI] 0.5-3.6). Major toxicity was less frequent in patients with pre-existing autoimmunity than patients without (67.7% vs 78.6%, respectively; adjusted odds ratio 0.55; 95% CI 0.31-0.99). Inpatient mortality did not differ significantly between groups.

Patients with pre-existing autoimmune disease had shorter hospital stays and lower risk of major toxicity following CAR T cell therapy for cancer treatment, offering reassurance as to its safety in this population while providing additional data for research studies of CAR T cell therapy to treat autoimmune diseases.