Chimeric Antigen Receptor T-Cell Emergencies: Inpatient Administration, Assessment, and Management

Abstract

Objective: Chimeric antigen receptor (CAR) T-cell therapy is a genetically modified cellular therapy approved for the treatment of acute lymphocytic leukemia and B-cell lymphoma. This therapy requires patients to remain hospitalized for at least 7 days to monitor for two black-box warnings: cytokine release syndrome and neurotoxicity. Both toxicities require astute monitoring and early treatment to prevent complication.

Data source: We use a case study to illustrate the assessment and toxicity management of a patient receiving CAR T-cell therapy for diffuse large B-cell lymphoma at an academic medical center.

Conclusion: Cytokine release syndrome and neurotoxicity are two common, potentially life-threatening toxicities that can be reversed with early nursing identification and treatment using evidence-based interventions.

Implications for nursing practice: Objective assessment and consensus grading is essential for identification and management of CAR T-cell toxicities.

Keywords: Chimeric antigen receptor; Cytokine release syndrome; Neurotoxicity.