Nursing Plays Important Roles in Various Settings During CAR-T Therapy for MM

Nurses play an essential role in helping patients navigate the process of chimeric antigen receptor T-cell (CAR-T) therapy for relapse/refractory multiple myeloma (RRMM), according to a study recently published in Seminars in Oncology Nursing.

CAR-T therapy has advanced treatment options for a hard-to-treat patient population who would otherwise need intensive chemotherapy or have few remaining treatment options. These patients and their caregivers will rely on nurses throughout the treatment process.

Acknowledging that overcoming barriers to this treatment is likely to increase demand for CAR-T therapy in the future, a team of researchers explored the roles of nursing during the CAR-T treatment process. They evaluated literature and synthesized the information with practical considerations gleaned from nurses and nurse practitioners with experience in CAR-T therapy administration for multiple myeloma.

Nurses have different roles in the CAR-T continuum of care, depending on the phase of treatment and the setting.  For example, community oncology nurses assess patients to determine their eligibility before referring them to a certified treatment center. Pretreatment workup includes echocardiography, pulmonary function tests, evaluation of functional status, and baseline laboratory testing.

Once the patient arrives at the certified healthcare facility, Risk Evaluation and Mitigation Strategies (REMS)-certified nurses are involved in patient education and the treatment process (ie, leukapheresis, bridging therapy, potential delays during manufacturing, lymphodepletion, and the CAR-T infusion).

Nurses trained to recognize the toxicities associated with CAR-T therapy work with the rest of the team to address adverse effects during postinfusion care. They monitor patients after CAR-T cell infusion for signs of toxicity.

CRS is a notable acute toxicity that can occur as early as 1 day postinfusion, with protocols to address indicators such as fever. Similarly, nurses must be aware of immune effector cell-associated neurotoxicity syndrome (ICANS), which can also develop posttherapy and can lead to symptoms such as encephalopathy, aphasia, motor weakness, tremor, and others.

In the future, more patients may be able to receive their infusions in outpatient settings, which also will require additional considerations on the part of nurses, such as the development of rapid inpatient admissions strategies, if hospital admission becomes necessary.

Additional important nursing care includes psychological support for patients and caregivers throughout the CAR-T process. Nurses with a strong understanding of the therapy and the treatment process can help patients and caregivers learn about what to expect.

“CAR-T therapies for RRMM represent a significant advancement in the treatment of this population, for which implementation requires significant contributions from nursing staff,” the researchers concluded. “Although the specific roles and responsibilities of nurses may differ across settings, all nurses working with patients with MM should be well versed in the CAR-T therapy eligibility criteria, treatment process, and implications for long-term monitoring of toxicities. As access continues to expand, nursing support will be crucial for successful outcomes.”

Disclosures: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.

Reference

Steinbach M, Zitella LJ, Florendo E, et al. Nursing care throughout the chimeric antigen receptor t-cell therapy process for multiple myeloma. Semin Oncol Nurs. Published online September 24, 2023. doi:10.1016/j.soncn.2023.151505