CAR T Cells: Keeping Pace With Adverse Effects of an Emerging Therapy

Chimeric antigen receptor T cells are T cells that have been collected and genetically modified to express a CAR immunoreceptor.
Chimeric antigen receptor T cells are T cells that have been collected and genetically modified to express a CAR immunoreceptor.
The following article features coverage from the 2017 Oncology Nursing Society's Annual Conference in Denver, Colorado. Click here to read more of Oncology Nurse Advisor's conference coverage.            

DENVER,CO — The oncology nurses' role in monitoring and early recognition of the signs and symptoms of chimeric antigen receptor T cell (CAR T-cell) toxicities is significant considering the potential severity of these adverse effects, according to a presentation at the 2017 Oncology Nursing Society Annual Congress.

Chimeric antigen receptor T cells (CAR T cells) are human T cells that are collected from the patient and genetically modified to express a CAR immunoreceptor. The modified CAR T cells target specific surface proteins on cancer cells. CAR T cell therapy is an emerging therapy for acute lymphoblastic leukemia, chronic lymphocytic leukemia, lymphoma, and multiple myeloma.

Prognosis for patients undergoing CAR T cell therapy is promising; however, adverse effects of the cells although transient may be severe or life threatening. In this presentation, Brenna Hansen, BSN, RN, OCN, of the Center for Cancer Research, National Cancer Institute in Bethesda, Maryland, described the common adverse effects related to CAR T cell therapy and highlighted the significance of nurses' appropriate identification of symptoms.

Cytokine release syndrome (CRS) CRS occurs when the CAR T cells recognize their target on cancer cells and release cytokines. The syndrome commonly manifests as fever, sometimes higher than 40° C, and lasting for several days. Some patients may develop hypotension, which if severe may require patient transfer to the intensive care unit for hemodynamic support. Other CRS-related adverse effects include, but are not limited to, hypoxia, cardiac arrhythmias, acute kidney injury, cytopenias, and myalgia.

Neurologic toxicities Signs and symptoms of neurologic toxicities in patients receiving CAR T cells include headache, confusion, tremors, ataxia, dysphasia, seizures, hallucinations, somnolence, and encephalopathy. These symptoms may or may not correspond directly with CRS.

CAR T cell type specific Patients receiving CAR T cells targeting CAR19 may develop B cell aplasia requiring IVIG. Graft-versus-host disease also is a potential adverse effect. As new targets for CAR T cell therapy emerge, nurses should assess patients carefully for potential new adverse effects.  

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