Poster Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2022

Nutritional status of patients undergoing Chimeric Antigen Receptor T-Cell (CAR-T) therapy; a feasibility study. (#324)

Danika Carty 1 , Hilmy Ismail 2 3 , Emily Traer 2 3 , Bernhard Riedel 2 3 4 , Nicole O'Leary 5 , Simon Harrison 5 , Jessica Crowe 6 , Erika Kotowicz 6 , Lara Edbrooke 7 8 , Maria Ftanou 9 , Erin Laing 1 , Jenelle Loeliger 1
  1. Nutrition and Speech Pathology Department, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
  2. Department of Anaesthetics and Perioperative Medicine, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
  3. Critical Care Department, University of Melbourne, Melbourne, Victoria, Australia
  4. The Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
  5. Department of Haematology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
  6. Physiotherapy and Occupational Therapy Department, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
  7. Health Services Research Department, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
  8. Department of Physiotherapy, The University of Melbourne, Melbourne, Victoria, Australia
  9. Psychosocial Oncology Program, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia

Background: CAR-T therapy is a novel treatment for haematological malignancies. Eligibility criteria in Australia are patients with multiply relapsed or refractory diffuse large b-cell lymphomas who have had two or more lines of systemic treatment (e.g. chemotherapy, stem cell transplant), all which are well documented to increase risk of malnutrition. There is limited information on the nutritional status of patients prior to, and following, CAR-T therapy.

Aims: To assess the nutritional status of patients before CAR-T therapy and observe post-treatment nutritional status, symptoms and dietetic interventions.

Methods: Eligible participants received proactive nutrition assessment and consultation prior to CAR-T therapy as part of a wider study evaluating the feasibility of multimodal prehabilitation (Nov 2020 – Dec 2021). Pre-treatment, nutritional status and sarcopenia were assessed using patient-generated subjective global assessment (PG-SGA), hand grip strength (HGS) and appendicular lean mass (ALM) via bioimpedance spectroscopy. Usual care was followed post-treatment. The need for dietetic intervention and frequency of nutrition-related symptoms post CAR-T therapy were recorded.

Results: Fifteen participants (54% female, mean age 61 years (45-71) and body mass index 24.7kg (19.4-33.9kg/m2) were included. All participants were well-nourished at baseline with one deemed sarcopenic (using cut-offs for HGS and ALM). Post CAR-T therapy, 33% (n=5) required dietetic intervention including oral nutrition support. Of these, common nutrition-related symptoms were nausea (n=3/5, 60%), vomiting, diarrhoea and dysgeusia (each n=2/5; 40%). At time of dietetic intervention, 80% (n=4/5) were malnourished (PG-SGA B/C).

Conclusions: In one-third of participants CAR-T therapy was associated with nutrition-related symptoms that required dietetic intervention, and 80% of participants receiving dietitian contact were malnourished, indicating risk of nutritional status decline post CAR-T. Further research is needed to investigate the nutritional implications of CAR-T therapy in a larger sample and to test the effectiveness of post-treatment nutrition interventions on nutritional outcomes in a randomised controlled trial.