Frontiers in Immunology (Oct 2023)

Mediport use as an acceptable standard for CAR T cell infusion

  • Maya Eylon,
  • Snehit Prabhu,
  • Samuel John,
  • Maxwell J. M. King,
  • Dhruv Bhatt,
  • Kevin J. Curran,
  • Courtney Erickson,
  • Nicole A. Karras,
  • Christine L. Phillips,
  • Christine L. Phillips,
  • Prakash Satwani,
  • Michelle Hermiston,
  • Erica Southworth,
  • Susanne H. C. Baumeister,
  • Julie-An Talano,
  • Margaret L. MacMillan,
  • Jenna Rossoff,
  • Challice L. Bonifant,
  • Gary Doug Myers,
  • Rayne H. Rouce,
  • Keri Toner,
  • Timothy A. Driscoll,
  • Emmanuel Katsanis,
  • Dana B. Salzberg,
  • Deborah Schiff,
  • Satiro N. De Oliveira,
  • Christian M. Capitini,
  • Holly L. Pacenta,
  • Holly L. Pacenta,
  • Thomas Pfeiffer,
  • Niketa C. Shah,
  • Van Huynh,
  • Jodi L. Skiles,
  • Ellen Fraint,
  • Kevin O. McNerney,
  • Troy C. Quigg,
  • Joerg Krueger,
  • John A. Ligon,
  • Vanessa A. Fabrizio,
  • Christina Baggott,
  • Theodore W. Laetsch,
  • Liora M. Schultz

DOI
https://doi.org/10.3389/fimmu.2023.1239132
Journal volume & issue
Vol. 14

Abstract

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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.

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