Background: Chimeric antigen receptor (CAR) T-cell therapy is increasingly used for relapsed/refractory non-Hodgkin lymphoma (NHL) and multiple myeloma (MM), offering improved outcomes but often complicated by cytokine release syndrome (CRS) and immune effector cell–associated neurotoxicity syndrome (ICANS). These toxicities can require corticosteroids, extend hospital stays, and lead to functional decline. However, the prevalence and predictors of rehabilitation needs after discharge remain unclear, limiting effective discharge planning and resource allocation. This study aims to assess the frequency and independent predictors of rehabilitation service utilization following CAR T-cell therapy.

Methods: We retrospectively reviewed adults who received their first commercial CAR T-cell infusion for NHL or MM between May 2017 and March 2024. Patients who survived ≥14 days with complete discharge data were included; those discharged to hospice or who died in-hospital were excluded. The primary outcome was discharge with formal rehabilitation support (home health, facility-based subacute, or inpatient) vs. home without services. Variables included age, sex, race/ethnicity, malignancy, ECOG status, CRS and ICANS severity per the ASTCT criteria and cumulative steroid exposure (0, 1–400, 401–1450, >1450 mg). Predictors with p < 0.10 or clinical relevance were entered into multivariable logistic regression. Survival analysis was performed as a secondary exploratory outcome This study was approved by the institutional review board and conducted as a retrospective chart review.

Results: Of 304 patients (NHL = 241, MM = 63), MM patients were older (65.5 vs. 61.6 years; p = 0.032), more often female (54% vs. 34%; p = 0.004), and Black (38% vs. 16%; p = 0.002). Most had ECOG 0–1 (91%). NHL patients primarily received axi-cel (74%), while MM patients received cilta-cel (48%) or ida-cel (52%). CRS and ICANS severity were similar between groups, though CRS duration (p < 0.001) and hospital stay (median 11 vs. 12 days; p = 0.04) were shorter in MM.

Overall, 16% (n = 49) required rehabilitation services, higher in MM than NHL (27% vs. 12%; p = 0.010). Rehabilitation needs increased with CRS severity (none: 17%; grade 1–2: 30%; grade ≥3: 50%; p = 0.016) and ICANS severity (none: 17%; grade 1–2: 35%; grade ≥3: 56%; p < 0.001).

On multivariable analysis, ECOG ≥2 was the strongest predictor (OR 22.9; 95% CI 5.8–90; p < 0.001). Age was associated with increased risk (OR 1.06 per year; 95% CI 1.03–1.10; p = 0.001). Steroid exposure showed a dose-response relationship: 401–1450 mg (OR 3.8; p = 0.003), >1450 mg (OR 7.4; p < 0.001) compared to no steroids. Additional lab predictors (CRP, ferritin, LDH) will be presented.

At a median follow-up of 73 months, 117 patients had died. Those discharged with rehabilitation had significantly worse unadjusted survival (median 35.0 months vs. not reached; p < 0.001). Rehab need remained an independent predictor of mortality (HR 2.4; 95% CI 1.6–3.6; p < 0.001) after adjusting for NHL vs MM.Conclusions: Approximately one-quarter of patients require formal rehabilitation after CAR T-cell therapy, most commonly those with older age, ECOG ≥ 2, or high corticosteroid exposure. Rehabilitation needs were independently associated with worse survival. Early identification and referral of high-risk patients to physical therapy may enhance recovery, reduce post-acute care needs, and improve outcomes. A multidisciplinary, individualized rehabilitation approach—initiated before infusion and continued through survivorship—can support functional recovery, quality of life, and successful reintegration.

This content is only available as a PDF.
2025
Sign in via your Institution