Evaluation of Toxicity Associated with CAR-T Cell Therapy and Nursing Interventions

Abstract

Objective: Chimeric antigen receptor (CAR)-T cell therapy is a new immunotherapy approach that has started to been used in recent years and is developing rapidly. CAR-T cells, which are used as an immunotherapy treatment, destroy the tumor cell both directly and by increasing the release of cytokines. Our aim in this study is to evaluate inpatient CAR-T cell therapy patients in our clinic in line with cytokine release syndrome (CRS) and CAR-T related encephalopathy syndrome (CRES) management and to guide clinical practices by sharing the nursing interventions we apply in the management of CAR-T cell post-treatment toxicities. Methods: Thirteen patients who received CAR-T cell therapy between 2020 and 2023 were included in this descriptive study. Following CAR-T cell infusion, the following nine-day period was retrospectively examined from the patients’ files. CRS toxicity findings that might occur after CAR-T cell infusion, CRES toxicity findings, cognitive findings recorded in the CARTOX-10 neurological evaluation form, as well as treatment methods and nursing interventions applied, were evaluated and recorded. Results: When we evaluated the CAR-T cell infusion toxicity findings, 38.46% of the patients had CRS stage 1, 30.79% had CRES stage 2, 15.38% had dysgraphia, 23.07% had cognitive impairment, 7.69% had somnolence and contraction in the arm and shoulder muscles were detected in 7.69%. It was determined that two patients were transferred to the intensive care unit due to both CRS and CRES toxicity findings. Conclusion: The role of nurses is important in monitoring and managing toxicity after CAR-T cell infusion, which is a new treatment option, in determining the patient’s clinical status changes, in the care of the patient, and in expanding the knowledge base on this subject.

Keywords

• car-t cell therapy
• hematology
• immunotherapy
• nursing