Dysphagia Outcomes Following Chimeric Antigen Receptor T-Cell (CAR-T) Treatment in Patients with Non-Hodgkin Lymphoma

Dysphagia is a well-established complication in cancer patients, often resulting from chemoradiation-induced inflammation, fibrosis, and neuromuscular dysfunction. However, little is known about the incidence and clinical impact of dysphagia in patients undergoing adoptive cellular therapies such as Chimeric Antigen Receptor T-cell (CAR-T) therapy.

In this retrospective cohort study, we evaluated 116 patients with non-Hodgkin's lymphoma (NHL) who received CAR-T therapy between January 2017 and May 2023. The overall prevalence of dysphagia was 19.83%, with a median onset of 6 days and a median duration of 14 days. Dysphagia was significantly associated with cytokine release syndrome (CRS) (p = 0.002), immune effector cell-associated neurotoxicity syndrome (ICANS) (p < 0.001), advanced tumor stage (p = 0.02), ICU admission (p < 0.001), and prolonged ICU stay (median 7 days). The Kaplan Meier analysis revealed significantly reduced 6-month overall survival in patients with dysphagia (59.01%) compared to those without (86.36%) (p = 0.001).

Dysphagia is an underrecognized but clinically significant complication of CAR-T therapy. Its association with severe treatment-related toxicities and poorer survival suggests the need for routine dysphagia screening and multidisciplinary management in CAR-T treated patients. Early recognition may guide supportive interventions and improve patient outcomes and quality of life.