Optimisation of patient-reported outcome measurement for haematological cancer patients receiving novel immunotherapies: perspectives of multi-stakeholders

Objectives: The primary objective of this project was to explore the challenges related to the implementation of patient-reported outcome measures (PROMs) in myeloma, lymphoma and leukaemia patients undergoing chimeric antigen receptor T-cell (CAR-T) and T Cell engager bispecific antibody (BsAbs) therapies. The secondary aims focused on identifying and promoting opportunities to optimise PROM use for improved alignment, consistency, and interpretability of PROM data related to these innovative treatments. Methods: Data was collected through online focus groups and interviews with patients, carers, representatives of patient organisations from myeloma, lymphoma, leukaemia communities, researchers, industry, regulatory and payer representatives. The information was transcribed for qualitative thematic analysis, using a deductive–inductive mixed approach. Results: A total of 38 individuals participated; 14 interviews were conducted with 16 participants and two focus groups were conducted with 15 and 19 participants in each. Challenges reported included the unique complexities within trials of CAR-T and BsAbs in haematologic cancers such as the logistical challenges in the early post-infusion period for CAR-T and the wide variety of different BsAbs side-effects for patients occurring over different time periods. Further difficulties included balancing stakeholders’ expectations, and uncertainties about what to measure and when. Conclusions: CAR-T and BsAbs therapies present distinct challenges for PROM to capture treatment-related side effects and burden accurately. Use of generic and disease-specific instruments risk missing key elements of patients’ experiences and the use of ad-hoc strategies to complement these tools presents challenges for evidence synthesis. Clearer guidance, including early high-frequency assessments, systematic inclusion of patient-important domains currently under-captured, continued PRO data collection beyond clinical progression and transparent and comprehensive reporting of PRO findings will lead to substantial improvements in understanding the impact of CAR-T and BsAbs treatments.