Nursing Management of Patients with CAR T-cell Therapy: A Case Study

Abstract

Cell therapy is an emerging treatment technology for hematologic cancers. It utilizes genetic engineering knowledge to modify T-cell receptor molecules to bind to specific proteins on the surface of cancer cells, without relying on the expression of genes and proteins on the cancer cell surface. This allows cell therapy to target and kill cancer cells precisely. Nurses play a crucial role in caring for patients undergoing cell therapy, from the admission process to assessing physical and mental readiness. These patients often endure suffering from multiple chemotherapy and/or radiotherapy regimens, leading to physical decline and anxiety due to previous treatment failures. Fear of disease recurrence or ineffective cell therapy constantly troubles patients. Establishing a relationship between nurses and patients is essential. Listening to patients’ thoughts and feelings about the treatment, their past experiences with illness, and assessing their understanding of cell therapy helps nurses gain deep insights into patients. Providing treatment information at appropriate times, informing patients about potential side effects such as fever, low blood pressure, or low blood oxygen levels, teaching patients to keep records, and instructing relatives to observe patients’ behavior, speech, and memory during treatment can be initiated from the first day of hospitalization. Any changes after cell therapy must be reported to the medical team immediately, as they may indicate complications such as acute inflammatory cytokine release syndrome or neurological disorders. Listening, providing information, and co-designing self-care processes with patients help alleviate anxiety, build trust in nurses, and foster cooperation with the treatment team, leading to positive nursing outcomes. This article aims to analyze patients’ health problems to enhance nurses’ understanding of risk factors, symptoms, and laboratory findings related to complications from cell therapy, and the role of nurses in managing these complications. This knowledge enables nurses to anticipate potential complications and provide timely assistance, reducing patient mortality. The case study involves a patient with stage 4 (diffuse large B-cell lymphoma) lymphoma, with lesions in the central nervous system and refractory disease, classified as having a poor prognosis. After responding to the third chemotherapy regimen, the patient continued treatment with cell therapy. During hospitalization, complications to monitor include: 1) tumor lysis syndrome, 2) acute inflammatory cytokine release syndrome, 3) neurological disorders known as ICANS, 4) severe acute allergic reactions, and 5) bone marrow suppression leading to low blood cell counts. Post-discharge, during the follow-up period after cell therapy, the patient is at risk of infection due to immune system dysfunction. During this period, patients must continue self-care at home. The total hospitalization period was 30 days. Laboratory follow-up over nine months revealed immune system dysfunction, with no detectable B-cell activity due to cell therapy’s inability to distinguish between normal and cancerous B-cells sharing the CD19 antigen. Immunoglobulin G levels, which protect against infections, were below standard, increasing the patient’s infection risk. Educating patients on self-care post-discharge and enhancing communication channels between the hospital and patients will boost patients’ confidence in self-care, adaptation, acceptance of treatment plans, and appropriate self-care.