Effects of BMI, Albumin and NRS 2002 Changes on Prognosis in Patients with Hematological Malignancies during CAR T Treatment

Background: CAR T-cell therapy has achieved good curative effect in relapsed and refractory hematological malignancies such as acute lymphoblastic leukemia, lymphoma, multiple myeloma. However, complications such as CRS, ICNAS, and infection seriously affect the safety of patient treatment. During the course of treatment, a large amount of energy consumption and nutrient loss are also produced due to the above-mentioned adverse reactions. This poor nutritional status is a comprehensive manifestation of the patient's tolerance to treatment. How to quantitatively evaluate the nutritional status of patients during CART treatment and its impact on the efficacy and prognosis remains to be explored.

Methods: Patients with hematological diseases who were treated with CAR T from August 2021 to December 2021 were selected as the research subjects. Nutritional risk screening 2002 (NRS 2002) was used for nutritional risk screening, and BMI, albumin, and NRS 2002 were used as indicators to evaluate nutritional status. Chi-square test, fisher exact test, k-m survival analysis, wilcoxon test and logistic regression analysis were applied to explore nutritional risk factors, and to investigate the impact of changes in BMI at admission and discharge, the lowest albumin at admission and after CART, and NRS 2002 at admission and discharge on patients' prognosis after CART treatment.

Results:

Sixty-one patients were enrolled, including 29 males and 32 females, with an average age of 54 years (21-87 years); there were 53 cases of lymphoma, 3 cases of acute lymphoblastic leukemia, and 5 cases of multiple myeloma; the median BMI was 21.95 (13.67-33.4), the median albumin was 41.3g/L (31-48.3g/L), and the median NRS 2002 was 2 points (2-4 points).

The BMI at admission and discharge were 22.24±3.46 VS 21.71±3.32 (P<0.001), and the lowest albumin at admission and after CART were 40.78±3.98 VS 35.37±3.76 (P<0.001),andthe NRS at admission and discharge was 2.16±0.42 VS 2.49±0.77 (P<0.001);

Univariate analysis was used to investigate the relation between the changes of BMI, albumin and NRS 2002 after CART treatmentandECOG, duration of fever, high fever>39℃, CRS grade.

1) Analysis of BMI changes showed that duration of fever ≥ 8 days had a significant effect on the decrease of BMI (P=0.03).

2) Analysis of changes in albumin showed that the decreased albumin level was associated with the occurrence of CRS (P<0.05); in addition, the decrease in albumin was related to high fever>39℃ (P=0.001).

3) Analysis of NRS changes showed significant differences in ECOG≧2 points, fever duration≧8d, high fever, and CRS≧ grade 2. (Table 1)

• The influence of nutritional status on prognosis:

(1) The influence of baseline nutritional status on prognosis: NRS≥3 points at admission (OR=0.20, 95% CI=0.045-0.918) was a risk factor for 3-month ORR (P=0.03).

(2) The influence of nutritional status changes on prognosis showed that the decrease in BMI had no significant effect on 3-month CR, 3-month ORR, PFS and OS; decreased albumin had an adverse effect on 3-month CR (OR=1.16, 95%CI=1.011-1.336, P=0.03) and had an adverse effect on PFS (HR=0.90, 95%CI=0.808-0.993, P =0.03; and deterioration of NRS2002 had adverse effects on OS (HR=3.41, 95% CI=1.096-10.604, P=0.03).

Conclusion: During the CART treatment, patients with hematological diseases have a higher risk of malnutrition, which is related to various factors such as baseline NRS, high fever after CART treatment, duration of high fever, and CRS response, which seriously affects the prognosis of patients. It is recommended to monitor the nutritional status of patients during CART treatment and intervene in time, so as to improve the nutritional status and prognosis of hospitalized patients.

No relevant conflicts of interest to declare.