Preparing Nurses for Possible Adverse Events with CAR-T Therapy

Cancer treatment using chimeric antigen receptor T-cells (CAR-T) engineered from a patient’s own T-cells has shown great promise at improving prognoses. Although this treatment option may provide complete remission, it is not without risks. Cytokine release syndrome (CRS) and cerebral edema can lead to serious adverse events that may be fatal.

Therefore, following principles of the FDA’s Risk Evaluation and Mitigation Strategy, Pamela Bicknell, BSN, RN, OCN®, BMT-CN, of the Mayo Clinic Florida (Jacksonville), and colleagues developed a multidisciplinary task force to educate nurses from the clinic’s Bone Marrow Transplant (BMT) and Intensive Care Units on specific concerns around CAR-T treatment.

The intent is to enable nursing staff to detect and manage signs and symptoms of both CRS and neurotoxicity early in CAR-T therapy. Ms Bicknell will present their program and current results at the Oncology Nursing Society (ONS) 44th Annual Congress, held in Anaheim, California.

Multiple approaches toward engaging staff in education involving CAR-T therapy were implemented by the task force, including educational breakfasts, pre- and posttesting, development of CRS and neurotoxicities quick-reference pocket guides, simulation center sessions, and a mock run of CAR-T infusion from harvest to transfusion. Patient and caregiver education was also included.

The task force has reported that BMT Unit nurses have successfully detected CAR-T treatment-related CRS and neurotoxicity signs and symptoms. To date, 8 CAR-T infusions have been completed. Complete remissions have been achieved for 2 patients.

Neurotoxicity became apparent following infusion for a 3rd patient who was then placed in intensive care. Of the 8 patients, 3 were transferred to a higher level of care and were subsequently transferred back to our unit after stabilization.

Reference

Bicknell P, Brown L, Moreno K, Muniz P. Achieving nurse readiness in the administration, management, and recognition of adverse reactions in patients receiving chimeric antigen receptor T-Cell (CAR-T) therapy. Poster presentation at: ONS 44th Annual Congress; April 11-14, 2019; Anaheim, CA.