Nuts and Bolts of Chimeric Antigen Receptor T-cell Therapy: Nursing Outlook

Abstract

Cancer, one of the dreaded diseases, imposes significant impact in mortality globally. Despite a multimodal cancer treatment approach, there still remains a lacuna in treating refractory disease and relapse. Chimeric antigen receptor (CAR) T-cell therapy is a revolutionary immunotherapy in the treatment of haematological malignancies, especially B-cell malignancies and some solid tumours where no treatment options exist. The T-cells are genetically modified to express CAR specific for a tumour antigen in a human leukocyte antigen-independent method, followed by ex vivo cell expansion and reinfusion back to the patient. Even with its rewarding results, CAR T-cell therapy bears significant acute and chronic toxicities such as effects of lymphodepletion, anaphylaxis, on target on tumour effect, on target off tumour effect, haemophagocytic lymphohistiocytosis, cytokine release syndrome and neurotoxicity. Nurses play a pivotal role throughout the Chimeric antigen receptor T (CAR T) cell therapy process in recruitment, leukapheresis, bridging therapy, lymphodepletion, CAR T-cell infusion, monitoring, documentation and follow-up. This article aims to provide nurses with an overview of the CAR T-cell therapy process and a framework to enable recognition, monitoring and grading of CAR T therapy-associated toxicities and the specialised nursing care entailed with it.