PC-03. Role of medical nurse in observation and evaluation of the patients after CAR-T therapy
Natalya P. Gusleva, Olga O. Molostova, Olga V. Pimenova, Larisa N. Shelikhova, Michael A. Maschan
Dmitry Rogachev National Medical Research Center, Moscow, Russia
Natalya P. Gusleva, phone: +7 (929) 594-24-62, e-mail: Nataljafirstname.lastname@example.org
CAR-T-therapy is a novel method of acute lymphoblastic leukemia (AML) treatment in children and adults. This therapy is developed for the patients who cannot achieve remission by any of existing drug therapies. CAR-T cell therapy is associated with risks of severe and life-threatening complications, i.e., cytokine release syndrome (CRS), and neurotoxicity (NT). Therefore, to perform timely diagnostics, careful and permanent follow-up is required in these patients. Medical nurses observe the patient and contact with him during the shift, thus allowing them to be the first and very important link when detecting complications of this therapeutic mode. Our aim was to assess probable complications when performing novel treatment method, and to implement the developed diagnostic scales into systematic evaluation of somatic and neurological state of the patients receiving CAR-T cell therapy into everyday activity of medical nurses.
Materials and methods
Since February 2018, CAR-T therapy was implemented at the D. Rogachev Medical Research Center of Pediatric Hematology, Oncology and Immunology in the frames of clinical trial. A total of 57 patients received this treatment. Since January 2021, the medical nurses initiated implementation of a score for evaluation of the patient receiving CAR-T cell therapy, according to the Consensus of American Society of Transplantation and Cellular Therapy (ASTCT). The scales of neurotoxicity evaluation were implied for the children of different ages as well CRS criteria. From the day of CAR-T cell infusion and over next 28 days, the medical nurses perform daily measurements of arterial blood pressure, body temperature, and saturation levels every 6 hours, aiming for CRS diagnostics. To assess neurotoxicity, the nurses use three scales: for infants (1-2 years), for patients under 12 years old, and for children over 12 years (CAPD, ICE scales). By means of special questions, observation and cooperation with patients during the working time, appropriate scores are registered, thus assessing the grade of neurotoxicity. The results are retrieved by the daily electronic records in the patient’s medical card.
Since January 2021, medical nurses at the Center perform active monitoring of the patients following CAR-T cell therapy using electronic records. Over this period, we performed monitoring of 7 patients at the age of 2 to 15 years. The observation results showed that all the patients exhibited CRS and neurotoxicity signs, with detailed information presented in Table 1.
Active, detailed and structured observation of the patients after CAR-T cell therapy by medical nurses allows to recognize the CRS and neurotoxicity signs at earlier terms, provides more careful control of the patient’s condition, as well as fast and clear information for attending doctors on appropriate changes, thus allowing to initiate treatment of these complications in due time.
CAR-T cell therapy, cytokine release syndrome, neurotoxicity, evaluation scores, nurse-assisted observation.
Table 1. Complications of CAR-T cell therapy