Value and affordability of CAR T-cell therapy in the United States.

Abstract:

:In the United States the increasing number of Food and Drug Administration (FDA)-approved, innovative, and potentially effective commercial cancer therapies pose a significant financial burden on public and private payers. Chimeric antigen receptor (CAR) T cells are prototypical of this challenge. In 2017 and 2018, tisagenlecleucel (Kymriah, Novartis) and axicabtagene ciloleucel (Yescarta, Kite) were approved by the FDA for use after showing groundbreaking results in relapsed/refractory B-cell malignancies. In 2020 and 2021, four further submissions to the FDA are expected for CAR T-cell therapies for indolent and aggressive B-cell malignancies and plasma cell myeloma. Yet, with marketed prices of over $350,000 per infusion for the two FDA-approved therapies and similar price tags expected for the coming products, serious concerns are raised over value and affordability. In this review we summarize recent, peer-reviewed cost-effectiveness studies of tisagenlecleucel and axicabtagene ciloleucel in the United States; discuss key issues concerning the health plan budget impact of CAR T-cell therapy; and review policy, payment and scientific approaches that may improve the value and affordability of CAR T-cell therapy.

journal_name

Bone Marrow Transplant

authors

Fiorenza S,Ritchie DS,Ramsey SD,Turtle CJ,Roth JA

doi

10.1038/s41409-020-0956-8

subject

Has Abstract

pub_date

2020-09-01 00:00:00

pages

1706-1715

issue

9

eissn

0268-3369

issn

1476-5365

pii

10.1038/s41409-020-0956-8

journal_volume

55

pub_type

杂志文章,评审
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    abstract::Safety of living donors is critical to the success of blood, tissue and organ transplantation. Structured and robust vigilance and surveillance systems exist as part of some national entities, but historically no global systems are in place to ensure conformity, harmonisation and the recognition of rare adverse events...

    journal_title:Bone marrow transplantation

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    doi:10.1038/bmt.2013.104

    authors: Shaw BE,Chapman J,Fechter M,Foeken L,Greinix H,Hwang W,Phillips-Johnson L,Korhonen M,Lindberg B,Navarro WH,Szer J

    更新日期:2013-11-01 00:00:00

  • Survival time of cardiac allografts prolonged by isogeneic BMT in mice.

    abstract::To find an approach to prolong the survival time of cardiac allografts in a BALB/c-to-C57/BL6 heterotopic heart transplant model and to try to figure out related chemokines and cytokines, isogeneic and allogeneic BM cells were obtained from pregnant C57/BL6 (♀C57/BL6 × ♂BALB/c) and regular BALB/c mice and injected to ...

    journal_title:Bone marrow transplantation

    pub_type: 杂志文章

    doi:10.1038/bmt.2011.215

    authors: Chen Z,Jiang H,Chen R,Feng S,Jin J,Bi Y,Yang H,Chen J

    更新日期:2012-08-01 00:00:00

  • Circulating progenitors following high-dose sequential (HDS) chemotherapy with G-CSF: short intervals between drug courses severely impair progenitor mobilization.

    abstract::Sequential administration of high-dose chemotherapy courses possibly allows extensive in vivo purging before circulating progenitor collection for autograft. To evaluate whether progenitor cell mobilization was negatively affected by repeated high-dose chemotherapy courses, we studied 23 lymphoma patients undergoing t...

    journal_title:Bone marrow transplantation

    pub_type: 杂志文章

    doi:

    authors: Tarella C,Caracciolo D,Gavarotti P,Bondesan P,Cherasco C,Omedè P,Bregni M,Siena S,Gianni AM,Pileri A

    更新日期:1995-08-01 00:00:00

  • Consolidation with a busulfan-containing regimen followed by stem cell transplantation in infants with poor prognosis stage 4 neuroblastoma.

    abstract::Although infants with stage 4 neuroblastoma (NB) usually have a good prognosis, metastatic relapses after 1 year of age and amplification of the N-myc oncogene are established poor prognostic factors. In order to improve the survival of patients with such high-risk factors, we performed consolidation with a busulfan (...

    journal_title:Bone marrow transplantation

    pub_type: 杂志文章

    doi:10.1038/sj.bmt.1702376

    authors: Valteau-Couanet D,Benhamou E,Vassal G,Stambouli F,Lapierre V,Couanet D,Lumbroso J,Hartmann O

    更新日期:2000-05-01 00:00:00

  • In vivo cytokine responses to interleukin-2 immunotherapy after autologous stem cell transplantation in children with solid tumors.

    abstract::The potent immunostimulatory cytokine interleukin-2 (IL-2) has been extensively investigated for its potential to induce anti-tumor immunity in a number of tumor models. Only recently the complex interplay of mutually suppressive or supportive cytokines of the IL-2-induced network of cytokines has been better characte...

    journal_title:Bone marrow transplantation

    pub_type: 临床试验,杂志文章

    doi:10.1038/sj.bmt.1702431

    authors: Bönig H,Laws HJ,Wundes A,Verheyen J,Hannen M,Kim YM,Banning U,Nürnberger W,Körholz D

    更新日期:2000-07-01 00:00:00

  • Adhesion molecules on peripheral blood-derived CD34+ cells: effects of cryopreservation and short-term ex vivo incubation with serum and cytokines.

    abstract::The homing of hematopoietic precursor cells (HPC) within the bone marrow is most likely to be mediated by specific adhesion via surface receptors to cellular and extracellular matrix (ECM) components and to be regulated by cytokines. We investigated the effects of serum and cytokines on the expression of adhesion mole...

    journal_title:Bone marrow transplantation

    pub_type: 杂志文章

    doi:10.1038/sj.bmt.1701484

    authors: Koenigsmann MP,Koenigsmann M,Notter M,Neuloh M,Mücke C,Thiel E,Berdel WE

    更新日期:1998-12-01 00:00:00

  • The CXCL12-3'A allele is associated with a higher mobilization yield of CD34 progenitors to the peripheral blood of healthy donors for allogeneic transplantation.

    abstract::The interaction between CXCL12 and its receptor CXCR4 plays a crucial role in the homing and mobilization of haematopoietic progenitors. We investigated the putative association between a CXCL12 gene polymorphism, the G --> A transition at position 801 in the 3'-untranslated region (3'UTR), and the yield of CD34(+) pr...

    journal_title:Bone marrow transplantation

    pub_type: 杂志文章

    doi:10.1038/bmt.2009.30

    authors: Bogunia-Kubik K,Gieryng A,Dlubek D,Lange A

    更新日期:2009-09-01 00:00:00

  • Fludarabine, low-dose busulfan and antithymocyte globulin as conditioning for Fanconi anemia patients receiving bone marrow transplantation from HLA-compatible related donors.

    abstract::Allogeneic hematopoietic stem cell transplantation (SCT) from unaffected donors remains the only modality for the correction of hematological abnormalities in Fanconi anemia (FA) patients. We performed four HLA-matched related donor SCT using a novel irradiation and cyclophosphamide-free conditioning regimen. The prot...

    journal_title:Bone marrow transplantation

    pub_type: 杂志文章

    doi:10.1038/sj.bmt.1704580

    authors: Maschan AA,Trakhtman PE,Balashov DN,Shipicina IP,Skorobogatova EV,Skvortsova YV,Dyshlevaja ZM,Samochatova EV,Rumiantsev AG

    更新日期:2004-08-01 00:00:00

  • Autotransplantation for relapsed or refractory Hodgkin's disease: long-term follow-up and analysis of prognostic factors.

    abstract::Seventy consecutive patients with refractory or relapsed Hodgkin's disease who received high-dose chemotherapy followed by autologous stem cell rescue were analyzed to identify clinically relevant predictors of long-term event-free survival. High-dose therapy consisted primarily of carmustine (BCNU), etoposide, cytara...

    journal_title:Bone marrow transplantation

    pub_type: 杂志文章

    doi:10.1038/sj.bmt.1701325

    authors: Lancet JE,Rapoport AP,Brasacchio R,Eberly S,Raubertas RF,Linder T,Muhs A,Duerst RE,Abboud CN,Packman CH,DiPersio JF,Constine LS,Rowe JM,Liesveld JL

    更新日期:1998-08-01 00:00:00

  • Monitoring of C-reactive protein after allogeneic bone marrow transplantation identifies patients at risk of severe transplant-related complications and mortality.

    abstract::Patterns of C-reactive protein (CRP) release were derived from frequent CRP measurements in a cohort of 66 consecutive patients receiving allogeneic bone marrow transplants (BMT) in our unit. Based on a retrospective study of clinical events occurring within the first 40 days after BMT, patients with major transplant-...

    journal_title:Bone marrow transplantation

    pub_type: 杂志文章

    doi:10.1038/sj.bmt.1701286

    authors: Schots R,Kaufman L,Van Riet I,Lacor P,Trullemans F,De Waele M,Van Camp B

    更新日期:1998-07-01 00:00:00

  • Graft-versus-adult T-cell leukemia/lymphoma effect following allogeneic hematopoietic stem cell transplantation.

    abstract::Allogeneic hematopoietic stem cell transplantation (allo-HSCT) has proven effective in adult T-cell leukemia/lymphoma (ATL) patients. To study the graft-versus-ATL (Gv-ATL) effects after allo-HSCT, we analyzed 21 ATL patients who had been treated at our hospital. Of these, 18 had acute-, 2 had lymphoma- and 1 had chro...

    journal_title:Bone marrow transplantation

    pub_type: 杂志文章

    doi:10.1038/bmt.2008.39

    authors: Yonekura K,Utsunomiya A,Takatsuka Y,Takeuchi S,Tashiro Y,Kanzaki T,Kanekura T

    更新日期:2008-06-01 00:00:00

  • Chimerism monitoring following allogeneic hematopoietic stem cell transplantation.

    abstract::Information regarding the chimeric status of hematopoietic stem cell transplantation (HSCT) recipients is of great significance when comparing different conditioning and prophylactic therapies. In recent years, short tandem repeats/variable number tandem repeats (STRs/VNTRs) have emerged as the best tool for chimerism...

    journal_title:Bone marrow transplantation

    pub_type: 杂志文章,随机对照试验

    doi:10.1038/sj.bmt.1705626

    authors: Talwar S,Khan F,Nityanand S,Agrawal S

    更新日期:2007-05-01 00:00:00

  • Respiratory syncytial virus infection in adult BMT recipients: effective therapy with short duration nebulised ribavirin.

    abstract::Respiratory syncytial virus (RSV), a common cause of both upper and lower respiratory tract infection (LRTI) in infants and children, is rarely described as an infective agent in adults. It has been reported in bone marrow transplant (BMT) recipients and patients with malignancy immunosuppressed by chemotherapy. Such ...

    journal_title:Bone marrow transplantation

    pub_type: 杂志文章

    doi:10.1038/sj.bmt.1701091

    authors: McColl MD,Corser RB,Bremner J,Chopra R

    更新日期:1998-02-01 00:00:00

  • Improvement of thrombocytopenia following bone marrow transplantation by pegylated recombinant human megakaryocyte growth and development factor in mice.

    abstract::We examined whether pegylated recombinant human megakaryocyte growth and development factor (PEG-rHuMGDF) is capable of improving thrombocytopenia and promoting thrombopoietic reconstitution following lethal irradiation and bone marrow transplantation (BMT) in mice. Immediately after receiving 10 Gy whole body irradia...

    journal_title:Bone marrow transplantation

    pub_type: 杂志文章

    doi:

    authors: Kabaya K,Shibuya K,Torii Y,Nitta Y,Ida M,Akahori H,Kato T,Kusaka M,Miyazaki H

    更新日期:1996-12-01 00:00:00

  • Effect of IL-7 or IL-4 on reconstitution of donor lymphoid cells in congenic murine bone marrow transplantation.

    abstract::IL-7 and IL-4 are known to influence the growth of cells of the lymphoid lineage. In this study, we investigated the effects of in vivo administration of IL-7 or IL-4 in mice subjected to congenic BM transplant. C57BL/6 Ly5.1+ mice were subjected to TBI, followed by transfer of B and T cell-depleted BM from C57BL/6 Ly...

    journal_title:Bone marrow transplantation

    pub_type: 杂志文章

    doi:

    authors: Mathur A,Vallera DA,Taylor PA,Widmer MB,Yang C,Prabhu A,Blazar BR

    更新日期:1995-07-01 00:00:00

  • Author Correction: High-dose chemotherapy and autologous stem cell transplantation in enteropathy-associated and other aggressive T-cell lymphomas: a UK NCRI/Cancer Research UK Phase II Study.

    abstract::In the original version of this article, the mention of 'ifosfamide 1500 mg/m2 days 1-3' should, in fact, read 'ifosfamide 1500 mg/m2 bd days 1-3'. This has now been updated in the original version of the article. ...

    journal_title:Bone marrow transplantation

    pub_type: 已发布勘误

    doi:10.1038/s41409-019-0504-6

    authors: Phillips EH,Lannon MM,Lopes A,Chadwick H,Jones G,Sieniawski M,Davies A,Wood K,Clifton-Hadley L,Smith P,Lawrie A,Chadwick N,Lennard AL

    更新日期:2020-04-01 00:00:00

  • Toxicity of high-dose busulphan and cyclophosphamide as conditioning therapy for allogeneic bone marrow transplantation in adults with haematological malignancies.

    abstract::The toxicity of the conditioning regimen high-dose busulfan (BU) 16 mg/kg followed by cyclophosphamide (CY) 200 mg/kg has been analysed in 60 adult patients (mean age 36 +/- 9 years) with haematological malignancies, a third of whom had advanced disease, all received the graft from fully HLA-identical siblings. Signif...

    journal_title:Bone marrow transplantation

    pub_type: 杂志文章

    doi:

    authors: Bandini G,Belardinelli A,Rosti G,Calori E,Motta MR,Rizzi S,Benini C,Tura S

    更新日期:1994-05-01 00:00:00

  • Immunological and electrophysiological investigations of severe ptosis after bone marrow transplantation.

    abstract::Ocular problems are common in recipients of stem cell transplantation (SCT), but ptosis is rarely reported and investigated. Among 346 consecutive SCT recipients, severe bilateral ptosis was noticed or reported in six cases (five women and one man), all with acute graft-versus-host disease (aGVHD) and chronic graft-ve...

    journal_title:Bone marrow transplantation

    pub_type: 杂志文章

    doi:10.1038/sj.bmt.1704608

    authors: Hon C,Mak W,Kwok AK,Au WY

    更新日期:2004-09-01 00:00:00

  • Risk factors for thrombotic microangiopathy in allogeneic hematopoietic stem cell recipients receiving GVHD prophylaxis with tacrolimus plus MTX or sirolimus.

    abstract::Transplantation-associated thrombotic microangiopathy (TA-TMA) is a feared complication of allogeneic hematopoietic SCT (HSCT) owing to its high mortality rate. The use of calcineurin inhibitors or sirolimus (SIR) for GVHD prophylaxis has been suggested as a potential risk factor. However, the impact of tacrolimus (TA...

    journal_title:Bone marrow transplantation

    pub_type: 杂志文章

    doi:10.1038/bmt.2014.17

    authors: Labrador J,López-Corral L,López-Godino O,Vázquez L,Cabrero-Calvo M,Pérez-López R,Díez-Campelo M,Sánchez-Guijo F,Pérez-López E,Guerrero C,Alberca I,Del Cañizo MC,Pérez-Simón JA,González-Porras JR,Caballero D

    更新日期:2014-05-01 00:00:00

  • Pulse cyclophosphamide for corticosteroid-refractory graft-versus-host disease.

    abstract::Corticosteroid-resistant GVHD is difficult to manage and is associated with high morbidity and mortality. Cyclophosphamide (Cy) is an established immunosuppressive and cytotoxic drug widely used as part of pretransplant conditioning regimens. In a retrospective study of 15 patients who had not responded to corticoster...

    journal_title:Bone marrow transplantation

    pub_type: 杂志文章

    doi:10.1038/sj.bmt.1704829

    authors: Mayer J,Krejcí M,Doubek M,Pospísil Z,Brychtová Y,Tomíska M,Rácil Z

    更新日期:2005-04-01 00:00:00

  • Impaired bone marrow hematopoietic progenitor cell function in rheumatoid arthritis patients candidated to autologous hematopoietic stem cell transplantation.

    abstract::We have evaluated bone marrow morphology, percentage of bone marrow CD34(+) cells, proliferative activity of bone marrow precursors, clonogenic assay (BFU-E and CFU-GM) in short-term bone marrow cultures, and bone marrow cell apoptosis, together with serum TNF-alpha and IL-6, in 16 chronic, refractory RA patients, as ...

    journal_title:Bone marrow transplantation

    pub_type: 杂志文章

    doi:10.1038/sj.bmt.1704407

    authors: Porta C,Caporali R,Epis O,Ramaioli I,Invernizzi R,Rovati B,Comolli G,Danova M,Montecucco C

    更新日期:2004-04-01 00:00:00

  • Monthly prospective analysis of hematopoietic chimerism after allogeneic hematopoietic cell transplantation.

    abstract:SUMMARY:Hematopoietic chimerism (HpC) was assayed monthly using a sensitive, polymerase chain reaction (PCR) -based method in consecutive patients. Between January 1998 and April 2002, 181 patients underwent non-T cell depleted allogeneic hematopoietic cell transplantation (HCT). A total of 163 patients were evaluable ...

    journal_title:Bone marrow transplantation

    pub_type: 杂志文章

    doi:10.1038/sj.bmt.1704147

    authors: Lee KH,Lee JH,Choi SJ,Lee JH,Kim S,Seol M,Lee YS,Kim WK,Kwon MR,Choi SJ,Park CJ,Chi HS,Lee JS

    更新日期:2003-08-01 00:00:00

  • The bare lymphocyte syndrome.

    abstract::The bare lymphocyte syndrome is a combined immunodeficiency resulting from the lack of expression of either class I or class II HLA antigens at the cell surface. The main clinical manifestations are infections of the respiratory or the digestive tract. The immunodeficiency involves the absence of antibody formation an...

    journal_title:Bone marrow transplantation

    pub_type: 杂志文章,评审

    doi:

    authors: Touraine JL,Marseglia GL,Betuel H,Souillet G,Gebuhrer L

    更新日期:1992-01-01 00:00:00

  • Transient engraftment of T cell-depleted allogeneic bone marrow in mice improves survival rate following lethal irradiation.

    abstract::C3H/HeJ mice were exposed to 8 or 9 Gy total body irradiation prior to transplantation of 1-15 x 10(6) H-2 incompatible T cell-depleted bone marrow cells from C57BL/6 donors. Survival was greatly enhanced compared to irradiated controls, even at the lowest cell doses. Analysis of spleen cells 1-7 weeks post-transplant...

    journal_title:Bone marrow transplantation

    pub_type: 杂志文章

    doi:

    authors: Lapidot T,Singer TS,Reisner Y

    更新日期:1988-03-01 00:00:00

  • Myelosuppressive chemotherapy to mobilize normal stem cells in chronic myeloid leukemia.

    abstract::Ten patients with Ph+ chronic myeloid leukemia (CML) were treated with idarubicin, cytarabine and etoposide followed by G-CSF to harvest Ph-negative progenitor cells. Six were in first chronic phase (CP1), and four beyond CP1. Between two and six aphereses (median 3, total 36) were performed starting 9-26 days (median...

    journal_title:Bone marrow transplantation

    pub_type: 杂志文章

    doi:

    authors: Mehta J,Mijović A,Powles R,Pagliuca A,Singhal S,Czepulkowski B,Swansbury GJ,Treleaven J,Mufti GJ

    更新日期:1996-01-01 00:00:00

  • Pilot study of combined cryosupernatant and protein A immunoadsorption exchange in the treatment of grade 3-4 bone marrow transplant-associated thrombotic microangiopathy.

    abstract::Bone marrow transplant-associated thrombotic microangiopathy (BMT-TM) ranges in severity from a self-limiting to a fatal disorder. There is no specific therapy for this condition to date. We have previously described a simple clinical grading system (grade 0-4) for BMT-TM; patients with grade 3-4 BMT-TM do poorly. A p...

    journal_title:Bone marrow transplantation

    pub_type: 杂志文章

    doi:

    authors: Zeigler ZR,Shadduck RK,Nath R,Andrews DF 3rd

    更新日期:1996-01-01 00:00:00

  • Are new conditioning regimens for transplants in acute myelogenous leukemia better?

    abstract::Pretransplant conditioning regimens designed to decrease leukemia relapse and increase leukemia-free survival in allotransplants in acute myelogenous leukemia (AML) were developed recently. We review studies of new regimens containing drugs like busulfan, cytarabine, melphalan or etoposide as well as novel radiation s...

    journal_title:Bone marrow transplantation

    pub_type: 杂志文章,评审

    doi:

    authors: Aurer I,Gale RP

    更新日期:1991-04-01 00:00:00

  • Early cyclosporine taper in high-risk sibling allogeneic bone marrow transplants.

    abstract::Graft-versus-tumour reactions as a form of adoptive immunotherapy may help prevent the recurrence of haematological malignancy following allogeneic BMT. We hypothesised that such reactions may be maximised by shortening the duration of post-transplant immunosuppression by a rapid taper of cyclosporine (CYA). CYA dose ...

    journal_title:Bone marrow transplantation

    pub_type: 临床试验,杂志文章

    doi:10.1038/sj.bmt.1700961

    authors: Abraham R,Szer J,Bardy P,Grigg A

    更新日期:1997-11-01 00:00:00

  • Effects of radiation and 4-hydroperoxycyclophosphamide on production of G- and GM-CSF by stromal cells.

    abstract::The effects of in vitro radiation and exposure to 4-hydroperoxycyclophosphamide (4-HC) on the production of G- and GM-CSF by different components of the human hematopoietic microenvironment are described. The marrow microenvironment is composed of fibroblasts, endothelial cells, macrophages, and adipocytes. To study t...

    journal_title:Bone marrow transplantation

    pub_type: 杂志文章

    doi:

    authors: Laver JH,Xu F,Barredo JC,Abboud MR

    更新日期:1992-12-01 00:00:00

  • Caspase-8 polymorphisms result in reduced Alemtuzumab-induced T-cell apoptosis and worse survival after transplantation.

    abstract::Allo-SCT using unrelated donors is a curative treatment for patients with hematological disorders. The best donor is one matched for 10/10 HLA alleles, however studies have shown an additional survival benefit when considering other genetic factors. It has been shown that a six-nucleotide insertion/deletion polymorphi...

    journal_title:Bone marrow transplantation

    pub_type: 临床试验,杂志文章,多中心研究

    doi:10.1038/bmt.2014.238

    authors: Shaw BE,Lee F,Krishnamurthy S,Byrne JL,Seedhouse C,Mayor NP,Maldonado-Torres H,Saudemont A,Marsh SG,Madrigal JA,Russell NH

    更新日期:2015-02-01 00:00:00