Review Article

Beyond CAR T-Cell Therapy: Continued Monitoring and Management of Complications

Victoria Reiser, RN, BSN, BMTCN, OCN®

From University of Pittsburgh School of Nursing, University of Pittsburgh Medical Center Shadyside, Pittsburgh, Pennsylvania

Author’s disclosure of conflicts of interest is found at the end of this article.

Correspondence to: Victoria Reiser, RN, BSN, BMTCN, OCN®, 3500 Victoria Street, Pittsburgh, PA 15261. E-mail: vlr11@pitt.edu


J Adv Pract Oncol 2020;11(2):159–167 | https://doi.org/10.6004/jadpro.2020.11.2.4 | © 2020 Harborside™


  

ABSTRACT

Chimeric antigen receptor (CAR) T-cell therapy has recently emerged as a groundbreaking treatment for CD19-expressing hematologic malignancies and received rapid approval by the U.S. Food & Drug Administration. Tisagenlecleucel and axicabtagene ciloleucel are now widely available at CAR T-cell therapy centers around the United States. Many patients have achieved complete response or remission despite failing multiple previous lines of therapy, but some patients endure the severe risks of cytokine release syndrome, neurotoxicity, and other immunologic effects. As more patients receive this therapy, they will present to their primary oncologists in the community setting for continued follow-up. Oncology-trained advanced practitioners must then have a working knowledge of CAR T-cell therapy, its toxicities, and follow-up care. This review presents the CAR T-cell therapy development and infusion process with associated immediate management. In addition, patient assessment and disease monitoring, relevant diagnostics, unique grading systems to CAR T-cell therapy toxicities, indications for hospitalization, infection prophylaxis, and management of nonneutropenic and neutropenic fever are presented. 




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