The oncology nurses’ responsibility in monitoring and recognizing symptoms of chimeric antigen receptor T-cell (CAR T-cell) toxicities is especially important, according to a presentation at the Oncology Nursing Society Annual Congress (May 4-7, 2017; Denver, CO).
Patients with acute lymphoblastic leukemia, chronic lymphocytic leukemia, lymphoma, and multiple myeloma who are undergoing CAR T-cell therapy have a positive prognosis. However, adverse events associated with CAR T-cell therapy may be severe or life-threatening, despite being short-lived.
Brenna Hansen, BSN, RN, OCN, Center for Cancer Research, National Cancer Institute (Bethesda, MD), described the adverse events associated with CAR T-cell therapy and relayed the significance of the nurses’ role in identifying problematic symptoms in her presentation.
Some of these symptoms include Cytokine release syndrome, which can manifest itself through fever, hypertension, hypoxia, cardiac arrhythmias, acute kidney cytopenias, and myalgia; neurologic toxicities, including headache, confusion, tremors, ataxia, dysphasia, seizures, hallucinations, somnolence, and encephalopathy; and CAR T-cell specific events, such as B-cell aplasia and graft-versus-host disease.
According to Hansen, severe symptoms can warrant the use of tocilizumab or corticosteroids, which temper the effects of T-cells. However, doing so should be avoided if possible to prevent any potential interference with the anti-malignancy effects of the CAR T-cells.
Nurses’ readiness to detect these adverse events, especially in their early stages, is essential to early intervention and safe management by the appointed multidisciplinary team. “Having a written plan can help prevent confusion and provide guidelines for the patient's care,” said Hansen.
Concluding remarks of the presentation included a call for established supportive care guidelines for adult patients receiving CAR T-cell therapy in order to aid oncology nurses in understanding and identifying symptoms to monitor and communicate with the medial team to allow early intervention.
Additionally, Hansen calls for nurses to carefully assess patients for potential new adverse events, especially as new targets for CAR T-cell therapy continue to emerge. — Zachary Bessette