OBJECTIVES: Since 2018, the lymphoma patient’s pathway has evolved with the innovative CAR T-Cell therapies and the progressive opening of qualified centers. The study objective was to describe the pathway of the patients treated by axi-cel and tisa-cel from 2018 to 2021, and to study its predictors.

METHODS: A retrospective cohort study was performed using the French comprehensive hospital database (Programme de Médicalisation des Systèmes d'Information, PMSI). Patients hospitalized for axi-cel and tisa-cel administration discharged between January 1, 2018, and December 31, 2021, were included. Patients treated for acute lymphoblastic leukemia and/or minors were excluded. The patient’s journey was described using the following indicators: the bridging therapy duration and setting, the length from CAR T-cell infusion to discharge, and the discharge modes. The predictors were identified among the patients' and centers’ characteristics, the CAR T-cell infused and the coverage method, using linear and logistic mixed-effect regression models.

RESULTS:

A total of 901 patients were included, 548 treated by axi-cel and 353 by tisa-cel. The mean age was 59.8 years (±12.6) and 61.3% were male (n=552). On average, the durations were 36.6 days (±15.8) for bridging therapies, and 18.1 days (±11.4) from CAR T-cell infusion to discharge. The proportion of patients attending another center for the bridging therapy was 43.5% (n=199). Most of the patients were discharged at home (74.8%, n=674). Center experience was the main predictor of patients’ pathways. Higher experience was associated with shorter post-infusion’s length of stay, higher probability to receive the bridging therapy in another center and to be discharged at home. Among patient-level characteristics, the absence of transplant’s history, and the treatment by tisa-cel were associated with shorter length of stay.

CONCLUSIONS:

Center experience was the main driver of the patient’s journey. These results should be updated with the growing experience of the qualified centers.