Longitudinal Patient-reported Outcomes in Patients Receiving Chimeric Antigen Receptor T-Cell Therapy.

CAR-T cell therapy has transformed treatment for relapsed/refractory hematologic malignancies but has complex logistics and unique toxicities. Data examining the patient-reported outcomes (PROs) of CAR-T recipients are limited. We conducted a longitudinal study of adults with hematologic malignancies receiving CAR-T at a single academic center. We assessed quality of life (QOL) (Functional Assessment of Cancer Therapy-General), psychological distress (Hospital Anxiety and Depression Scale, Patient Health Questionnaire-9, post-traumatic stress disorder [PTSD] checklist) and physical symptoms (Edmonton Symptom Assessment Scale-revised) at baseline, 1 week, 1 month, 3 months, and 6 months post CAR-T infusion. We utilized linear mixed models to identify factors associated with QOL trajectory. We enrolled 72.5% (103/142) of eligible patients (3 did not receive CAR-T). QOL (B=1.96, p<0.001) and depression symptoms (B=-0.32, p=0.001) worsened by 1 week then improved by 6 months post CAR-T. At 6 months, 18%, 22%, and 22% of patients reported clinically significant depression, anxiety, and PTSD symptoms, respectively. At 1 week, 52% noted severe physical symptoms, declining to 28% at 6 months post CAR-T. In unadjusted linear mixed models, worse ECOG performance status (B=1.24, p=0.042) receipt of tocilizumab (B=1.54, p=0.042) and receipt of corticosteroids for CRS and/or ICANS (B=2.05, p=0.006) were associated with higher QOL trajectory. After CAR-T, QOL declined and depression symptoms increased early followed by improvement in QOL, psychological distress, and physical symptoms by 6 months post infusion. A significant minority of patients report substantial psychological distress and physical symptoms longitudinally, underscoring the need for supportive care interventions.