Toxicity consensus guidelines have been published and are being translated into clinical practice (Lee et al., 2018 Mahmoudjafari et al., 2019 Neelapu et al., 2018 Teachey, Bishop, Maloney, & Grupp, 2018). Evidence for best management strategies continues to evolve however, specific interventions may vary based on institutional practice. Hospitalization and intensive care unit admission for treatment of CRS and neurologic toxicity symptoms may be needed. REMS programs require authorized centers to comply with specific guidelines to mitigate the risks of treatment. Both products are available only through Risk Evaluation and Mitigation Strategy (REMS) programs (Kite Pharma, 2018 Novartis Pharmaceuticals, 2018b). Food and Drug Administration (FDA)–approved CAR T-cell agents (i.e., axicabtagene ciloleucel and tisagenlecleucel ) because of their potential for life-threatening or fatal side effects. Black-box warnings for cytokine release syndrome (CRS) and neurologic toxicities exist for U.S. However, management of treatment-related toxicities is a significant concern (Abramson et al., 2018 Maude et al., 2018 Neelapu et al., 2017 Schuster et al., 2017). As organizational and institutional guidelines emerge, nurses must be aware of anticipated toxicities and interventions used in clinical practice to provide timely and effective care.Ĭhimeric antigen receptor (CAR) T-cell therapy targeting CD19 has been associated with dramatic treatment responses in B-cell acute lymphoblastic leukemia (ALL) and large B-cell lymphomas. Methods: An overview of recent guidelines and evidence for CAR T-cell therapy toxicity assessment and management is provided.įindings: Evidence-based approaches to CAR T-cell therapy toxicities continue to evolve. Implications for nursing practice are included for prominent toxicities to guide clinical practice. Objectives: This article presents an overview of pathophysiology, assessment, and evidence-based management of CAR T-cell therapy–associated toxicities, with particular attention paid to CRS and neurologic toxicity management. Cytokine release syndrome (CRS) and neurologic toxicities have emerged as prominent toxicities associated with this treatment modality. I couldn’t ask for more and hope to continue to work with them for as long as we need them.Background: The impressive disease response observed with chimeric antigen receptor (CAR) T-cell therapy is accompanied by the potential for unique and severe toxicities.
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She has a very practical and considered approach looking at his therapy with a long-term view as well as being highly adaptable to focus on any immediate changes.Īs a parent taking on the role of case manager for my son, I have found her professional knowledge and support invaluable.Īs a parent of a child with additional needs, we have fought for many years to give him access to education and therapies and ATtherapy has consistently worked with me, learnt from me about my son and been able to use their professional experience and knowledge to support him in the best way. Not only is she professional, knowledgeable, and friendly, she was able to build a good rapport with him very quickly and has consistently supported him positively in his growth identifying areas to focus on and improve upon. My son has worked with Emma Bowers, Specialist Speech and Language Therapist for approximately 3 years now. Trust ATtherapy with your communication needs. Our team of highly experienced therapists are all members of the Health and Care Professions Council (HCPC) and the Royal College of Speech and Language Therapists (RCSLT) who define the professional standards we follow. We all hold enhanced DBS checks and are approved to work with adults and children. We have specialist expertise in the field of Alternative and Augmentative Communication (AAC) and Assistive Technology (AT) and, and our award-winning team of AAC Mentors and communicators will be happy to share their experiences with you. face-to-face sessions at your home, school or workplace.We offer a wide range of services to meet your needs, including:
We have provided speech and language therapy expertise for many years to support people with communication problems. Our expert team of speech and language therapists assess, diagnose and provide therapy for people with speech, language and communication and/or swallowing problems to help them communicate to the best of their ability.
At ATtherapy, we believe in building richer lives through communication.
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