Predicting Outcomes After CAR T-Cell Therapy: A Novel Scoring System Assessing Physical Function With Megan Herr, PhD
Expert Perspectives · Keira Smith · 2025-03-31
At the recent Tandem Transplantation & Cellular Therapy Meetings of the American Society for Transplantation and Cellular Therapy (ASTCT) and Center for International Blood and Marrow Transplant Research (CIBMTR), Megan Herr, PhD, a Clinical Epidemiologist at Roswell Park Comprehensive Cancer Center, presented an abstract on the scoring system that she and her team developed to identify patients with non-Hodgkin lymphoma at risk of adverse outcomes after chimeric antigen receptor (CAR) T-cell therapy. The scoring system assessed physical functioning prior to receiving CAR T-cell therapy and its association with one-year mortality or risk of developing immune effector cell–associated neurotoxicity syndrome (ICANS).
In this interview, Dr. Herr shares additional insights into this research and how it can be used to improve patient outcomes following CAR T-cell therapy.
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Oncology Data Advisor: Dr. Herr, thank you for joining us today to tell us about this novel scoring system. What challenge does the scoring system address, and how did you go about developing it to predict which patients are most likely to experience serious side effects or adverse outcomes after CAR T-cell therapy?
Dr. Herr: For patients who have received CAR T-cell therapy, ICANS is a frequent toxicity which may have long-term complications. It only has a few predictors. We evaluated all the physical function measures that our physical therapists perform on our patients with ICANS and overall survival. We took the significant measures and added them to the model to ascertain if they would predict the outcomes of interest.
Oncology Data Advisor: What results did you find regarding which patients were at the highest risk?
Dr. Herr: Use of an assistive device, having less than 5/5 strength, and having a positive Romberg test were associated with risk of death at one year. Patients who had 2 or more adverse physical function measures (use of an assistive device, less than 5/5 strength, and a positive Romberg test) and a high CAR-HEMATOTOX score were at highest risk of death at one year. Patients who had a recent fall within the past 6 months and who could not balance on their left leg for at least 10 seconds had the highest risk of developing ICANS.
Oncology Data Advisor: What are the clinical implications of the results?
Dr. Herr: This scoring system can better inform clinicians and patients of the expected effects of CAR T-cell therapy.
Oncology Data Advisor: What are the next steps for validating and potentially implementing this scoring system into clinical practice?
Dr. Herr: We would like to collaborate with another institution to validate our findings. We built a risk score calculator to help implementation, which will be available once the manuscript is published.
Oncology Data Advisor: How do you see this research influencing the future of personalized treatment approaches in CAR T-cell therapy, particularly for patients with compromised physical function?
Dr. Herr: We will be able to use this scoring system to predict which patients will have a successful outcome with CAR T-cell therapy and which patients will not. The decision to proceed with therapy is ultimately the clinician and patient’s.
Oncology Data Advisor: Do you have any words of advice for clinicians regarding how to best support and optimize outcomes for their patients with non-Hodgkin lymphoma receiving CAR T-cell therapy?
Dr. Herr: Taking into consideration the side effects, time spent in the hospital, and other risks, including personal costs, if a patient only has a 9% chance of survival at one year after CAR T-cell therapy, that information should be shared with the patient so they are able to make an informed decision regarding their therapy. Conversely, if the patient has a 91% chance of survival with no adverse physical function measures and a low CAR-HEMATOTOX score, providing the patient with that knowledge is equally important.
About Dr. Herr
Megan Herr, PhD, is a Clinical Epidemiologist in the Transplant and Cellular Therapy Program at Roswell Park Comprehensive Cancer Center. Her research focuses on hematopoietic cell transplant outcomes, including graft-versus-host disease, infections, second cancers, relapse, and treatment-related mortality, as well as cellular therapy outcomes, including infections and neurotoxicity.