Real-world clinical outcomes of CAR-T therapy from the Montefiore health system in the Bronx

Chimeric antigen receptor T-cell (CAR-T) therapy has transformed diffuse large B-cell lymphoma (DLBCL) treatment, but data in diverse urban populations remain limited. We report outcomes from a comprehensive cancer center in the Bronx. Montefiore Health System treated 79 DLBCL patients with CAR-T from March 2018 to July 2024. Demographics, comorbidities, socioeconomic factors, and acute complications, including immune effector cell neurotoxicity syndrome (ICANS), cytokine release syndrome (CRS), cardiotoxicity, and pulmonary events, were tabulated. Kaplan-Meier survival analysis was performed up to five years. Multivariate adjusted hazard ratios (aHR) were calculated for remission and 3-year mortality. CAR-T achieved complete remissions in 50.6%, partial remission in 16.5%, and progression in 22.8%. Cumulative mortality was 10.1% during treatment and 34.2% by five years. Complete remission reduced 3-year mortality (aHR 0.13; 95% CI 0.04-0.43). Complications included CRS (76.0%), ICANS (49.4%), neutropenic fever (58.2%), and sepsis (19.0%). ICANS correlated with CRS, ICU stay, and sepsis. Socioeconomic status was not linked to mortality, but comorbidities increased risk. CAR-T complete remission is an independent predictor of reduced mortality. High rates of complications, particularly CRS and ICAN, reinforce the need for vigilant monitoring and management strategies to enhance long-term outcomes.