Introduction: Mediport 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.
Methods: In 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.
Results: Across 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/conclusion: Based 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.Reference:
Eylon M, Prabhu S, John S, King MJM, Bhatt D, Curran KJ, Erickson C, Karras NA, Phillips CL, Satwani P, Hermiston M, Southworth E, Baumeister SHC, Talano JA, MacMillan ML, Rossoff J, Bonifant CL, Myers GD, Rouce RH, Toner K, Driscoll TA, Katsanis E, Salzberg DB, Schiff D, De Oliveira SN, Capitini CM, Pacenta HL, Pfeiffer T, Shah NC, Huynh V, Skiles JL, Fraint E, McNerney KO, Quigg TC, Krueger J, Ligon JA, Fabrizio VA, Baggott C, Laetsch TW, Schultz LM. Mediport use as an acceptable standard for CAR T cell infusion. Front Immunol. 2023 Oct 27;14:1239132. doi: 10.3389/fimmu.2023.1239132. PMID: 37965315; PMCID: PMC10642031.