Clinical Scorecard: Safety and effectiveness of implanted ports for CAR T-cell infusion in large B-cell lymphoma
At a Glance
Category
Detail
Condition
Large B-cell lymphoma (LBCL) treated with commercially available CAR T-cell therapy.
Key Mechanisms
The retrospective study compared CAR T-cell expansion, safety, and clinical outcomes after infusion through an implanted port versus a PICC or CVC. Peripheral-blood CAR T-cell levels were measured by flow cytometry after infusion.
Target Population
504 patients with LBCL treated with commercially available CAR T-cells at a single center; 202 received infusion through a port and 302 through a PICC or CVC.
Care Setting
Single-center clinical care setting. The study compared vascular access used for CAR T-cell infusion and assessed outcomes after infusion.
Key Highlights
In this retrospective cohort of 504 patients, 202 received CAR T-cell infusion through a port and 302 through a PICC or CVC.
CRS, ICANS, line-associated infection, and prolonged cytopenia rates were comparable between access groups.
VTE was less frequent with ports than with PICC/CVC access (3.0% vs 9.3%; p = 0.006).
Day 30 and day 90 complete metabolic response rates and median PFS and OS did not differ significantly by access type.
Multivariable analyses found no significant association between access type and toxicity or efficacy endpoints except for lower VTE rates associated with port use.
Guideline-Based Recommendations
Diagnosis
The study included patients with large B-cell lymphoma who received commercially available CAR T-cell therapy; it did not evaluate diagnostic criteria or diagnostic procedures.
Management
The study compared CAR T-cell infusion through an existing implanted port with infusion through a PICC or CVC. It did not establish a preferred vascular-access strategy or a new treatment guideline.
Patients who were not receiving therapeutic anticoagulation received prophylactic anticoagulation during inpatient hospitalization according to institutional guidelines, with adjustment for renal function and platelet count.
Monitoring & Follow-up
The study measured peripheral-blood CAR T-cell levels by flow cytometry on postinfusion days 1, 3, 5, 7, 9, 11, 13, 15, 17, 19, 21, and 28.
The study assessed line-associated local infection and VTE occurring within 30 days after infusion and defined prolonged cytopenia as persistence for at least 30 days.
Risks
CRS, ICANS, line-associated infection, and prolonged cytopenia rates were comparable between port and PICC/CVC groups.
VTE occurred less frequently in the port group than in the PICC/CVC group (3.0% vs 9.3%; p = 0.006). This retrospective association does not establish that port use caused the difference.
Patient & Prescribing Data
504 patients with LBCL treated with commercially available CAR T-cells at a single center; 40% received infusion through a port and 60% through a PICC/CVC.
Access type was not significantly associated with CAR T-cell expansion, response, PFS, OS, or most reported toxicities. Port use was associated with lower VTE frequency in this cohort.
Clinical Best Practices
The authors report that an existing port was used for CAR T-cell infusion and compare outcomes with PICC/CVC access; the study does not establish a new access guideline.
In this cohort, patients not receiving therapeutic anticoagulation received prophylactic anticoagulation during inpatient hospitalization only, according to institutional guidelines and adjusted for renal function and platelet count.
The study graded CRS and ICANS using ASTCT criteria, cytopenias and line-associated infection/VTE using CTCAE criteria, and response using Lugano 2014 criteria.
Related Resources & Content
Blood Cancer Journal, 2026 -- Safety and efficacy of port use for CAR T-cell infusion in large B-cell lymphoma
ASCO Publications, 2022 -- Real-world analysis of safety and efficacy of CAR T-cell therapy in patients with lymphoma with decreased renal function
ASCO Publications, 2024 -- Safety and feasibility of outpatient CAR-T therapy: A single center analysis
ASCO Publications — Efficacy and safety of commercial CD19 CAR-T (inaticabtagene autoleucel) in relapsed/refractory extramedullary B-ALL: A large multicenter real-world study.
ASCO Publications — Late infectious complications after CD19-directed chimeric antigen receptor T-cell (CAR-T) therapy for large B-cell lymphomas (LCBL): Real-world predictors and outcomes.
Safety and efficacy of port use for CAR T-cell infusion in large B-cell lymphoma
NCCN Guidelines Version 1.2025
NCCN Guidelines Version 1.2025
CD19 CAR-T cell therapy in large B-cell lymphoma: clinical evidence, resistance, toxicity, and precision strategies - PMC
Safety and efficacy of port use for CAR T-cell infusion in large B-cell lymphoma | Blood Cancer Journal
by Zachary E. Hunzeker, Anath Lionel, Xiaowen Sun, Lei Feng, Sairah Ahmed, Amy Ayers, Michelly de Castro, Jaimole Varghese, Karla Ow, Taylor Cain, Minifrida Santiago, Sreekala Nair, Jeremy Ramdial, Elizabeth J. Shpall, Sattva S. Neelapu, Paolo Strati
