Caregivers, Clinicians Must Be Familiar With CRS Risk After CAR T-Cell Therapy

Education on CAR T-cell therapy side effects is paramount.

When treating patients with myeloma with CAR T-cell therapy, it is essential that patients have social support at home and that members of the healthcare team clearly and openly communicate with one another, explained Nick Barkemeyer, PA.

Barkemeyer is a physician assistant at Tennessee Oncology in Nashville. At a recent Community Case Forum, he discussed the use of CAR T-cell therapies for patients with multiple myeloma.

He described the autologous CAR T-cell process as, “the reprogramming of the patient's own T cells to directly attack the tumor cells,” and noted that there are 2 CAR T-cell therapies approved for relapsed/refractory myeloma: Ciltacabtagene autoleucel (Carvykti) and Idecabtagene vicleucel (Abecma).^1-2

Patient and Caregiver Education on CRS from CAR T-Cell Therapy

Considering CAR T-cell therapy’s involved process, it is not yet available at all cancer centers. Patients being treated in the community setting may have to go elsewhere to receive CAR T-cell therapy, and all patients undergoing this type of treatment must know the risks and side effects to look out for after they go home.

In fact, a poll of forum attendees asked, “Which is the most critical aspect to address during the transition of care from inpatient to outpatient following CAR T-cell therapy?” All respondents (100%) chose the answer, “Education on managing potential side effects at home.”

Later, another question was asked: What should be the highest priority in patient education regarding self-management during the outpatient transition after CAR T-cell therapy? Once again, the answer was unanimous. One hundred percent of attendees chose, “Recognizing symptoms of cytokine release syndrome (CRS).”

CRS is a serious potential adverse effect of CAR T-cell therapy. According to the National Cancer Institute, signs of CRS include fever, nausea, headache, rapid heartbeat, low blood pressure, and trouble breathing. The organization mentioned that although most cases of CRS are mild, the symptoms can be severe or life-threatening.³

Barkemeyer shared an anecdote of a patient who went to the emergency department with CRS.

“They sent him to the [intensive care unit], and they intubated the poor guy, and all he needed was some steroids, probably,” he said. “Social support is key, and probably it's better to have people who are taking care of you who are educated and what to look for [and] where to go.”

Clinician Communication During CAR T-Cell Therapy

Support and collaboration among clinicians are also key when treating patients with CAR T-cell therapy, especially as not all cancer centers—especially in the community setting—offer this type of treatment, according to Barkemeyer.

“I think as time goes on, basically we’re all going to have to learn and talk and communicate with one another and try to coordinate things to make it as easy as possible for patients… The goal is to eventually make it more accessible in the community,” he said.

References

1. U.S. FDA approves CARVYKTI™ (ciltacabtagene autoleucel), Janssen’s first cell therapy, a BCMA-directed CAR-T immunotherapy for the treatment of patients with relapsed or refractory multiple myeloma. News release. Janssen. February 28, 2022. https://bit.ly/35yWwjv
2. U.S. FDA Approves Bristol Myers Squibb and 2seventy bio’s Abecma for Triple-Class Exposed Relapsed or Refractory Multiple Myeloma After Two Prior Lines of Therapy. News release. Bristol Myers Squibb and 2seventy bio. April 5, 2024. Accessed April 5, 2024. https://news.bms.com/news/corporate-financial/2024/U.S.-FDA-Approves-Bristol-Myers-Squibb-and-2seventy-bios-Abecma-for-Triple-Class-Exposed-Relapsed-or-Refractory-Multiple-Myeloma-After-Two-Prior-Lines-of-Therapy/default.aspx
3. Cytokine Release Syndrome. National Cancer Institute. Accessed November 13, 2024. https://www.cancer.gov/publications/dictionaries/cancer-terms/def/cytokine-release-syndrome