CAR-T (chimeric antigen receptor)-T cells

[Buckeye.nurse]

I've cared for several relapsed DLBCL patients recently who are considering this pretty new therapy. I've been educating myself on CAR-T, and the studies look promising. Does anyone have experience caring for patients who have received this regimen?

UpToDate

Hopefully the link works!

[Nursemedlin]

The hospital system that I work for just started doing CAR-T cell therapy. I work in the adjacent outpatient infusion center and I recently attended a presentation that one of our Pharm-D folks put together. He has been working closely with these patients. From what I gathered the main concern is cytokine release syndrom (CRS). When it happens it hits fast and is severe. We have these patients in ICU as close monitoring is required. If CRS happens they use high dose steroids (sounds counterintuitive, I know but they work quickly) and then the steroids are tapered quickly - over 2-3 days.

There was a series called First In Human on the Discovery channel last year that followed a patient at the NIH that received CAR-T cell therapy. If you haven't seen it already it is worth watching.

[Buckeye.nurse]

The hospital system that I work for just started doing CAR-T cell therapy. I work in the adjacent outpatient infusion center and I recently attended a presentation that one of our Pharm-D folks put together. He has been working closely with these patients. From what I gathered the main concern is cytokine release syndrom (CRS). When it happens it hits fast and is severe. We have these patients in ICU as close monitoring is required. If CRS happens they use high dose steroids (sounds counterintuitive, I know but they work quickly) and then the steroids are tapered quickly - over 2-3 days.

There was a series called First In Human on the Discovery channel last year that followed a patient at the NIH that received CAR-T cell therapy. If you haven't seen it already it is worth watching.

I will have to check the Discovery channel series out! The actual CAR-T protocol happens on my facility's BMT unit which has ICU nurse patient ratios. We care for patients on my unit who are undergoing chemo or high dose steroids as a bridge while they attempt to get into the program. They also sometimes have apheresis cell harvest while still on my unit.

I've seen cytokine release syndrome in patients I've cared for who are receiving Blinatumomab. It's a bit scary how quickly CRS can happen.