Reappraisal of a renovated cell-free and concentrated ascites reinfusion therapy (KM-CART) for malignant ascites

Abstract

Abstract Background Renovated cell-free and concentrated ascites reinfusion therapy (KM-CART) has become widely practiced, but the actual clinical efficacy has been reported rarely. The aim of this study was to evaluate the outcomes of KM-CART for malignant ascites. Methods We performed 226 KM-CART procedures in 104 patients with malignant ascites in three hospitals from August 2013 to September 2018. Medical records were retrospectively reviewed for ascites data, related complications, symptoms before and after each CART and prognosis after the first CART. We reviewed the modified Glasgow Prognostic Score (mGPS) before every procedure, as an indicator of nutritional status. Results Pancreatic cancer was the most common indication for the CART procedure, followed by gastric cancer, hepatocellular carcinoma, ovarian cancer, and cholangiocarcinoma (five major diseases). The 50% survival times of these five major diseases after the first procedure were 25, 39, 31, 49, and 33 days, respectively. The mean survival time for all patients was 73.5 days, and 75.6 days for those with the five major diseases. All patients experienced symptomatic relief, and complications were rare. Repeated KM-CART was performed in 47.1% of the patients, most often in those with ovarian cancer (66.7%). As for the mGPS at the first CART procedure, 89% of patients were in the group with the poorest nutritional status. The mGPS score improved in only two patients during treatment and was not related to prognosis. Conclusions KM-CART gives the benefit of improved ascites-related symptoms and general condition, even in a short time and with a poor nutritional status.