BackgroundIn 2017, Massachusetts General Hospital implemented the Severe Immunotherapy Complications (SIC) Service, a multidisciplinary care team for patients hospitalized with immune-related adverse events (irAEs), a unique spectrum of toxicities associated with immune checkpoint inhibitors (ICIs). This study’s objectives were to evaluate the intervention’s (1) effect on patient outcomes and healthcare utilization, and (2) ability to collect biological samples via a central infrastructure, in order to study the mechanisms responsible for irAEs.MethodsA hospital database was used to identify patients who received ICIs for a malignancy and were hospitalized with severe irAEs, before (April 2, 2016–October 3, 2017) and after (October 3, 2017–October 24, 2018) SIC Service initiation. The primary outcome was readmission rate after index hospitalization. Secondary outcomes included length of stay (LOS) for admissions, corticosteroid and non-steroidal second-line immunosuppression use, ICI discontinuation, and inpatient mortality.ResultsIn the pre-SIC period, 127 of 1169 patients treated with ICIs were hospitalized for irAEs; in the post-SIC period, 122 of 1159. After SIC service initiation, reductions were observed in irAE readmission rate (14.8% post-SIC vs 25.9% pre-SIC; OR 0.46; 95% CI 0.22 to 0.95; p=0.036) and readmission LOS (median 6 days post-SIC vs 7 days pre-SIC; 95% CI −16.03 to –0.14; p=0.046). No significant pre-initiation and post-initiation differences were detected in corticosteroid use, second-line immunosuppression, ICI discontinuation, or inpatient mortality rates. The SIC Service collected 789 blood and tissue samples from 234 patients with suspected irAEs.ConclusionsThis is the first study to report that establishing a highly subspecialized care team focused on irAEs is associated with improved patient outcomes and reduced healthcare utilization. Furthermore, the SIC Service successfully integrated blood and tissue collection safety into routine care.
Introduction: Myeloproliferative neoplasms (MPNs), polycythemia vera (PV), essential thrombocytosis (ET) and myelofibrosis (MF), are clonal stem cell neoplasms that commonly harbor the JAK2V617F mutation. Recent preclinical studies suggest that the JAK2V617F mutation in hematopoietic stem cells accelerates pathologic cardiac remodeling, potentially contributing to HF. However, the prognostic significance of HF hospitalization in MPNs has not been studied. Methods: Single-center, retrospective cohort study of patients with MPN with ≥ 1 HF hospitalization after MPN diagnosis from 2000-2020 (N = 105, 39 ET, 39 PV, 27 MF). Our outcomes were death (cardiovascular [CV] and all-cause mortality [ACM]) and recurrent HF hospitalization after index hospitalization. To assess predictors of CV death and ACM, we used a multivariable logistic regression using age, sex, LVEF ≥ 50% at index event, cardiology follow-up 3 months after index, pulmonary hypertension (PH) before index, MF, treatment of MPN, NT-proBNP at index, CAD, hypertension, prior stroke, diabetes, and arterial thrombosis (AT) after index (stroke or MI) as co-variables. Results: After median follow-up time of 19 months (IQR 5, 19, full characteristics in Table), CV death, ACM, recurrent HF, AT occurred in 30%, 55%, 54%, 12%, respectively. After multivariable regression, recurrent HF (aOR 5.3, 95% CI 1.7-19.3), PH (aOR 3.2, 95% CI 1.0-10.7) and AT (aOR 4.4, 95% CI 1.1-21.5) were associated with increased odds of CV death. Close cardiologist follow-up (aOR 0.2, 95% CI 0.05-0.7) and LVEF ≥ 50% (aOR 0.3, 95% CI 0.1-0.9) were associated with decreased odds of CV death. Only recurrent HF was associated with increased odds of ACM (aOR 2.5, 95% CI 1.0-6.5). Conclusions: Patients with MPN who have multiple HF hospitalizations have high rates of CV death and ACM. Closer cardiology follow-up pre and post HF hospitalization may improve outcomes in this population and more research is needed to improve cardiovascular outcomes.
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