Impact of Malnutrition on Length of Stay for Hospitalized CAR T Therapy Patients in the United States (2020)
Authors: Ren Tong , Kerr Daniel , Olu Oyesanmi , Muddassir Salman 
Published: December 2024

Background
Chimeric Antigen Receptor (CAR) T-cell therapy offers a promising treatment for certain malignancies, but can be associated with complications. Malnutrition and cachexia are common in cancer patients and may worsen outcomes. This study investigated the impact of malnutrition on the length of hospital stay (LOS) in patients with hematologic malignancies undergoing CAR T therapy. The analysis focused on different subpopulations, including those with Acute Lymphoblastic Leukemia (ALL), Multiple Myeloma, Diffuse Large B-cell Lymphoma (DLBCL), Non-Hodgkin Lymphoma (NHL) excluding DLBCL.
Methods
Utilizing the 2020 National Inpatient Sample (NIS) data, we performed survey-based mean estimation analyses for LOS across various subpopulations of CAR T therapy patients. These subpopulations were defined by specific diagnoses: ALL, Myeloma, DLBCL, NHL excluding DLBCL. We compared LOS between patients with and without malnutrition using STATA accounting for the complex survey design. Cachexia was included as disease-induced malnutrition.
Results
The total CAR T population used for analyses including 439 patients, malnutrition was present in 50 (11.39%). The overall CAR T population demonstrated a significantly longer LOS for patients with malnutrition (30.92 days, 95% CI: 24.30 to 37.54) compared to those without malnutrition (17.97 days, 95% CI: 15.48 to 20.46, p=0.0002). This trend held true across subgroups.
Specifically, the ALL population had a significantly longer LOS with malnutrition (45.25 days, 95% CI: 35.46 to 55.04) compared to non-malnourished patients (27.58 days, 95% CI: 16.74 to 38.42, p= 0.0279). For the DLBCL population, the mean LOS was 24.47 days (95% CI: 19.22 to 29.71) with malnutrition and 17.17 days (95% CI: 13.29 to 21.04, p=0.0161) without. The NHL population excluding DLBCL exhibited a mean LOS of 33.86 days (95% CI: 22.66 to 45.07) for malnourished patients and 17.44 days (95% CI: 14.76 to 20.11, p=0.0055) for non-malnourished patients. The myeloma population showed similar trend although not statistically significant, with a mean LOS of 39.00 days (95% CI: -3.54 to 81.54) for malnourished patients and 18.03 days (95% CI: 15.02 to 21.03, p=0.3337) for non-malnourished patients.
These findings highlight significant variations in LOS across different CAR T-treated cancer subtypes, emphasizing the impact of malnutrition on healthcare resource utilization in oncology.
Conclusion
Malnutrition is associated with a significantly longer hospital stay among patients undergoing CAR T therapy. This trend is consistent across various subpopulations, including those with ALL, DLBCL, NHL (excluding DLBCL). While the impact of malnutrition on LOS was not statistically significant in the Myeloma, this could potentially be attributed to the smaller sample size in this group. This finding underscores the critical role of nutritional status in managing CAR T therapy patients and potentially improving their outcomes. Future studies should investigate the most effective methods for identifying and treating malnutrition in this patient population to reduce hospital stays and optimize overall patient care. The study is limited by its reliance on ICD-10 codes for malnutrition and cachexia, further studies are warranted investigating specific biomarkers and clinical characteristics associated with cachexia.