NURSING SURVEILLANCE AND RECOGNITION OF TOXICITIES FOLLOWING CAR-T CELL THERAPY: EXPERIENCE FROM VINMEC TIMES CITY INTERNATIONAL HOSPITAL
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Abstract
Background: CAR‑T cell therapy is an effective treatment for relapsed or refractory hematologic malignancies but carries risks of acute toxicities, particularly cytokine release syndrome (CRS) and immune effector cell‑associated neurotoxicity syndrome (ICANS). Nurses play a central role in early detection and coordinated management of these toxicities.
Objective: To describe the characteristics of post‑CAR‑T toxicities (CRS and ICANS) and evaluate nursing activities in monitoring and early identification using a standardized CAR‑T care checklist at Vinmec Times City International General Hospital.
Methods: A retrospective descriptive study was conducted on 16 patients treated with CAR‑T therapy from August 2023 to June 2025. Data were collected from electronic medical records, nursing care sheets, and CAR‑T monitoring checklists. Variables included CRS/ICANS rates and grades according to ASTCT 2019, time to symptom onset, time to nursing documentation of abnormalities, and time to physician notification.
Results: CRS occurred in 13/16 patients (81.2%), predominantly grade 1–2 (92.3%); ICANS occurred in 2 patients (12.5%), all grade 1. Median time to first symptom onset was 17 hours post‑infusion (IQR: 8–22 hours). Median time from symptom onset to nursing documentation was <5 minutes (IQR: 0–5 minutes); median time from documentation to physician notification was 5 minutes (IQR: 3–5 minutes). Tocilizumab was used in 56.3% of patients, corticosteroids in 18.8%. One patient required ICU admission; no mechanical ventilation or treatment‑related deaths occurred.
Conclusion: Post‑CAR‑T toxicities were predominantly mild‑to‑moderate CRS. The standardized CAR‑T care checklist enabled nurses to identify and report suspected toxicity signs promptly, supporting early intervention and enhancing patient safety.
Keywords
CAR‑T, post‑infusion toxicity, cytokine release syndrome, CRS, nursing, ICANS
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References
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