Dr. Ligon on Delivering CAR T-cell Therapy via Mediport Lines in Pediatric B-Cell Malignancies

John Ligon, MD, assistant professor, Department of Pediatrics, the University of Florida College of Medicine, discusses findings from a study investigating the use of mediports to deliver CAR T-cell therapy in patients at Pediatric Real-World CAR Consortium (PRWCC) medical centers.

This retrospective study, which aimed to determine real-world clinical patterns of mediport use for CAR T-cell infusion and recommend mediports as a new standard for CAR T-cell administration, was based on data from a survey distributed to 35 PRWCC medical centers, which deliver CAR T-cell therapy to children and young adults with B-cell malignancies. The survey collected data about each responding center’s practice patterns regarding venous access for CAR T-cell therapy infusion and related incidences of infiltration. The responding centers reported their current and previous practices going back to 2017, when the first FDA-approved CAR T-cell therapy, tisagenlecleucel (Kymriah), became commercially available for pediatric and young adult patients with acute lymphoblastic leukemia.

Of the 35 PRWCC centers, 34 responded to the survey and were included in the study, Ligon says. All responding centers reported using standard tunneled central venous catheters such as Broviac and Hickman lines, Ligon notes. Of the responding centers, 85% (n = 29) also reported successfully administering CAR T-cell therapy through mediport lines, with none of these centers reporting complications that can arise with this method, such as infiltration into soft tissues around the line, Ligon emphasizes. In addition, 6 of the centers reported successful use of peripheral intravenous (IV) lines for CAR T-cell administration, Ligon says.

These positive outcomes with the use of mediports and peripheral IVs to administer CAR T-cell therapy in the pediatric setting challenge the historical standard of exclusively administering cellular therapy products through central venous lines, Ligon notes. In particular, these findings show that mediports are currently accepted at several centers and are a safe way to administer CAR T cells, Ligon concludes.