Mediport use as an acceptable standard for CAR T cell infusion

Frontiers in Immunology

Immunology

Rayne H. Rouce¹  Dana B. Salzberg²  Gary Doug Myers³  Maya Eylon⁴  Maxwell J. M. King⁴  Vanessa A. Fabrizio⁵  Holly L. Pacenta⁶  Susanne H. C. Baumeister⁷  Dhruv Bhatt⁸  Julie-An Talano⁹  Christian M. Capitini^1,10  Nicole A. Karras^1,11  Theodore W. Laetsch^1,12  Courtney Erickson^1,13  Christina Baggott^1,13  Snehit Prabhu^1,13  Liora M. Schultz^1,13  Margaret L. MacMillan^1,14  Kevin O. McNerney^1,15  Kevin J. Curran^1,16  Samuel John^1,17  Emmanuel Katsanis^1,18  Satiro N. De Oliveira^1,19  Christine L. Phillips^2,20  Keri Toner^2,21  Deborah Schiff^2,22  Joerg Krueger^2,23  Prakash Satwani^2,24  Jenna Rossoff^2,25  Ellen Fraint^2,26  John A. Ligon^2,27  Van Huynh^2,28  Timothy A. Driscoll^2,29  Jodi L. Skiles^3,30  Thomas Pfeiffer^3,31  Troy C. Quigg^3,32  Challice L. Bonifant^3,33  Erica Southworth^3,34  Michelle Hermiston^3,34  Niketa C. Shah^3,35 

[1] Bone Marrow Transplant/Stem Cell Transplant Program, Texas Children’s Cancer Center, Houston, TX, United States;Center for Cancer and Blood Disorder, Phoenix Children’s Hospital, Phoenix, AZ, United States;Children’s Mercy Hospital, University of Missouri, Columbia, MO, United States;College of Medicine, Central Michigan University, Mount Pleasant, MI, United States;Colorado Children’s Hospital, University of Colorado, Boulder, CO, United States;Cook Children's Hematology and Oncology, Cook Children’s Hospital, Fort Worth, TX, United States;Department of Pediatrics, Department of Pediatrics, Children’s Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, United States;Dana-Farber/Boston Children’s Cancer and Blood Disorders Center, Dana Farber/Boston Children’s Hospital, Boston, MA, United States;Department for Biology, Stanford University, Palo Alto, CA, United States;Department of Pediatric Hematology Oncology, Medical College of Wisconsin, Milwaukee, WI, United States;Department of Pediatrics and Carbone Cancer Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States;Department of Pediatrics, City of Hope National Medical Center, Duarte, CA, United States;Department of Pediatrics, Department of Pediatrics, Children’s Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, United States;Department of Pediatrics, Division of Hematology and Oncology, Stanford University School of Medicine, Palo Alto, CA, United States;Department of Pediatrics, Division of Pediatric Blood and Marrow Transplantation, University of Minnesota Medical School, Minneapolis, MN, United States;Department of Pediatrics, John Hopkins All Children’s Hospital, St. Petersburg, FL, United States;Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY, United States;Department of Pediatrics, The University of Texas Southwestern Medical Center/Children’s Health, Dallas, TX, United States;Department of Pediatrics, University of Arizona, AZ, United States;Department of Pediatrics, University of California Los Angeles (UCLA) Mattel Children’s Hospital, Los Angeles, CA, United States;Department of Pediatrics, University of Cincinnati, Cincinnati, OH, United States;Cincinnati Children’s Hospital Medical Center, Cancer and Blood Disease Institute, Cincinnati, OH, United States;Division of Blood and Marrow Transplant and CAR-T Program, Children’s National Hospital, Northwest, DC, United States;Division of Hematology/Oncology, Rady Children’s Hospital, San Diego, CA, United States;Division of Hematology/Oncology, The Hospital For Sick Children, Toronto, ON, Canada;Division of Pediatric Hematology, Oncology and Stem Cell Transplant, Department of Pediatrics, Columbia University Medical Center, New York, NY, United States;Division of Pediatric Hematology, Oncology and Stem Cell Transplantation, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, United States;Division of Pediatric Hematology, Oncology, and Cellular Therapy, The Children’s Hospital at Montefiore, Bronx, NY, United States;Health Pediatric Blood & Marrow Transplant and Cellular Therapy, University of Florida, Gainesville, FL, United States;Pediatric Oncology, CHOC Children’s Hospital of Orange County, Orange County, CA, United States;Pediatric Transplant and Cellular Therapy, Duke Children’s Hospital & Health Center, Durham, NC, United States;Riley Children Health, Indiana University Health, IN, United States;Saint Louis Children’s Hospital One Children’s Pl, Saint Louis, MO, United States;Section of Pediatric BMT and Cellular Therapy, Helen DeVos Children’s Hospital, Grand Rapids, MI, United States;Sidney Kimmel Comprehensive Cancer Center, Division of Pediatric Oncology, Philadelphia, MD, United States;University of California, San Francisco Benioff Children’s Hospital, San Francisco, CA, United States;Yale Medicine, Yale University and Yale New Haven Children’s Hospital New Haven, New Haven, CT, United States;

关键词: chimeric antigen receptor T cell;    immunotherapy;    cancer;    immune cell engineering;    mediport;    implanted catheter;   

DOI  :  10.3389/fimmu.2023.1239132

 received in 2023-06-12, accepted in 2023-09-14,  发布年份 2023

来源: Frontiers

【 摘 要 】

IntroductionMediport use as a clinical option for the administration of chimeric antigen receptor T cell (CAR T cell) therapy in patients with B-cell malignancies has yet to be standardized. Concern for mediport dislodgement, cell infiltration, and ineffective therapy delivery to systemic circulation has resulted in variable practice with intravenous administration of CAR T cell therapy. With CAR T cell commercialization, it is important to establish practice standards for CAR T cell delivery. We conducted a study to establish usage patterns of mediports in the clinical setting and provide a standard of care recommendation for mediport use as an acceptable form of access for CAR T cell infusions. MethodsIn this retrospective cohort study, data on mediport use and infiltration rate was collected from a survey across 34 medical centers in the Pediatric Real-World CAR Consortium, capturing 504 CAR T cell infusion routes across 489 patients. Data represents the largest, and to our knowledge sole, report on clinical CAR T cell infusion practice patterns since FDA approval and CAR T cell commercialization in 2017. ResultsAcross 34 sites, all reported tunneled central venous catheters, including Broviac® and Hickman® catheters, as accepted standard venous options for CAR T cell infusion. Use of mediports as a standard clinical practice was reported in 29 of 34 sites (85%). Of 489 evaluable patients with reported route of CAR T cell infusion, 184 patients were infused using mediports, with no reported incidences of CAR T cell infiltration. Discussion/ConclusionBased on current clinical practice, mediports are a commonly utilized form of access for CAR T cell therapy administration. These findings support the safe practice of mediport usage as an accepted standard line option for CAR T cell infusion.

【 授权许可】

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Copyright © 2023 Eylon, Prabhu, John, King, Bhatt, Curran, Erickson, Karras, Phillips, Satwani, Hermiston, Southworth, Baumeister, Talano, MacMillan, Rossoff, Bonifant, Myers, Rouce, Toner, Driscoll, Katsanis, Salzberg, Schiff, De Oliveira, Capitini, Pacenta, Pfeiffer, Shah, Huynh, Skiles, Fraint, McNerney, Quigg, Krueger, Ligon, Fabrizio, Baggott, Laetsch and Schultz