(1311) Impact of Physical Therapy Interventions on Deconditioning and Functional Status After CAR-T Therapy

Introduction: Despite incorporating physical therapy (PT) into CAR T-cell therapy, some patients develop significant muscle weakness impairing their physical function and quality of life. No data are available describing the impact of CAR T-cells on functional status (FS). We aimed to assess CAR T-cell therapy’s impact on FS and identify associated risk factors.

Methods: Retrospective data on AMPAC scores (6=bed bound, 24=independent), a validated score to evaluate FS and guide interventions, from patients treated 11/2017-01/2021 were analyzed. AMPAC scores were recorded before CAR T-cell infusion and at hospital discharge. Risk factors known to impact FS in hospitalized patients were also collected. Summary statistics including median and range for continuous variables and frequency counts and percentages for categorical variables. Fisher exact test and Wilcoxon rank sum test were used to compare groups.

Results: 192 patients received CAR T-cells, 129 (67.2%) were evaluated by PT. Only 55 patients (28.6%) had AMPAC scores prior to cell infusion and at time of discharge. Median hospital stay was 29 (13-79) days with a median of 8 (2-26) PT interventions. Neurotoxicity (ICANS) occurred in 96.4% and 61.8% required ICU admission. Prior to CAR T-cell infusion 23.6% of patients were unable to walk without assistance (AMPAC≤17). At hospital discharge 54.5% of patients suffered a decline in AMPAC score and 49.1% of patients were unable to walk without assistance. Reduction in AMPAC scores was also present in patients who had no functional impairment (AMPAC≥22) at baseline. No significant differences were found in demographics, baseline LDH, number of prior lines of therapy, baseline AMPAC score, severity of toxicities, inflammatory markers or use of corticosteroids between patients with worsened FS and those without.

Conclusions: There is significant decline in FS of CAR T-cell therapy patients, including those with good FS prior to infusion, emphasizing the need for early PT intervention. The study was limited by a small sample and selection bias with high ICU admission rates compared to usual (61.8% versus 25-35%). Future research should explore early PT intervention in patients receiving CAR T-cell therapy. Future research should explore early PT intervention in patients receiving CAR T-cell therapy.