Disseminated intravascular coagulation in chimeric antigen receptor T-cell therapy: a 6-year nationwide analysis of clinical outcomes and health care resource utilization in patients with hematologic malignancies.

BACKGROUND: Disseminated intravascular coagulation (DIC) is a recognized complication of chimeric antigen receptor (CAR) T-cell therapy and contributes to treatment-related morbidity and mortality. However, data on its clinical and financial impact remain limited. OBJECTIVES: This study examined the characteristics and outcomes associated with DIC among hospitalizations for hematologic malignancies undergoing CAR-T cell therapy using national U.S. data. METHODS: Adult hospitalizations with acute lymphoblastic leukemia, non-Hodgkin lymphoma, or multiple myeloma who received CAR T-cell therapy (2017-2022) were identified from the National Inpatient Sample. Hospitalizations were stratified by DIC status, and survey-weighted analyses were performed to generate national estimates. Multivariable regression was used to assess differences in mortality and other outcomes (P < .05). RESULTS: Among 10,450 weighted CAR T-cell therapy hospitalizations, 220 (2.1%) developed DIC. In-hospital mortality was significantly higher in hospitalizations with DIC (22.7% vs 2.4%; adjusted odds ratio [aOR], 10.96; 95% confidence interval [CI], 4.78-25.09). DIC was associated with higher odds of acute kidney injury (aOR, 6.01), respiratory failure (aOR, 9.96), and shock (aOR, 18.55) and greater use of renal replacement therapy, mechanical ventilation, and vasopressors. DIC was also associated with higher odds of gastrointestinal hemorrhage (aOR, 12.41) and greater transfusion needs. DIC was associated with longer hospital stays (β = +17.6 days; P < .001) and higher hospitalization charges (β = +$523,323; P = .02). CONCLUSIONS: DIC is an infrequent yet severe complication of CAR T-cell therapy, associated with increased mortality, organ dysfunction, critical care utilization, transfusion needs, prolonged hospitalization, and higher charges. These findings underscore the importance of clinical vigilance and early intervention strategies.