Physical Recovery After CAR-T Cell Therapy vs. Autologous Stem Cell Transplantation Assessed Through Quantitative Rehabilitation Measures

Vollständiger Abstract

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Introduction: Chimeric Antigen Receptor T (CAR-T) cell therapy and autologous stem cell transplantation (ASCT) are both associated with significant physical and psychological challenges during post-transfusion recovery. To date, most assessments of physical recovery rely on subjective measures, which are prone to individual perception and bias. Direct comparative data on objective physical function between these therapies remain lacking. Objective: The study aims to compare physical recovery trajectories following CAR-T cell therapy and ASCT using objective and standardized rehabilitation assessments to identify promising endpoints for future trials. Methods: a total of 331 intraindividual rehabilitation assessments conducted at hospital admission and discharge were retrospectively screened for the Berg Balance Scale (BBS), muscle strength (MS), Timed Up and Go (TUG), 5-Times Sit-to-Stand (5×STS), and 6-minute Walk Test (6MWT). Subjective assessments including self-reported health status and fatigue measured by a Visual Analog Scale were also recorded. Results: Twelve patients met the inclusion criteria and completed all rehabilitation assessments (five CAR-T, seven ASCT). In the ASCT group, 6MWT performance declined significantly from admission to discharge (median change −84 m; range −415 to −31 m; p = 0.016), while CAR-T recipients showed a non-significant numerical improvement (median change +79 m; range −40 to +148 m; p = 0.19). Between-group comparison of 6MWT change favored CAR-T therapy (p = 0.005). For BBS, TUG, 5×STS and MS, no statistically significant within-group changes were observed, although trends suggested better preservation of balance and mobility in the CAR-T group. Conclusions: This pilot study provides preliminary comparative evidence suggesting that patients receiving CAR-T therapy may better preserve functional endurance than those undergoing ASCT, measured by the 6MWT. These findings are consistent with the existing literature highlighting the sensitivity and clinical relevance of the 6MWT in detecting functional changes, supporting its inclusion in standard rehabilitation assessments.