Leukemia is the number one cause of pediatric cancer mortality. In addition, there are poor outcomes for second and greater relapses of ALL, so there is a need for new novel therapies (Novartis, 2015). Chimeric antigen receptor-engineered T cells (CAR T cells) have yielded unprecedented efficacy in B cell malignancies, most remarkably in anti-CD19 CAR T cells for B cell acute lymphoblastic leukemia (B-ALL) with up to a 90% complete remission rate. (Wang, Wu Han, 2017). Because CAR-T therapy success can be contingent on factors such as disease burden and previous therapy, communication between referring and referral centers to facilitate rapid consultation is essential.
Team members from centers who offer CAR-T therapy can help facilitate communication with both the internal and referring centers to achieve success. The workshop will discuss the issues to consider when starting a CAR T program, referring to a CAR-T center, coordinating consultation visits, cell collections, bridging chemotherapy, cell infusion, and post-infusion care. A review of CAR-T therapy, its process, physiology, and goals will be presented along with nursing interventions that are needed in each step of the process. Aspects of the care of the patient receiving CAR-T therapy, including education and preparation will be offered. Ongoing communication between centers will be discussed for the pre-infusion, infusion, and post-infusion stages. Information presented will encompass data collection to assist referrals, preparation of patients and families, and nursing care during all stages. The role of commercial products vs. participation in a clinical trial will be presented.
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