iwNHL 2018 | CAR-T super users: teams to closely monitor patients receiving CAR T-cells

Bianca Santomasso

Bianca Santomasso, MD, PhD, of the Memorial Sloan Kettering Cancer Center, NY, recommends that patients with neurotoxicity due to CAR T-cell therapy should be followed in the hospital and monitored by a neurologist, who is more familiar in recognizing patterns to effectively manage the conditions. What is helpful, as Dr Santomasso suggests, is that a close-knit team of care providers, so-called ‘CAR-T super users’, see patients on a daily basis and are able to work collaboratively to make each other aware of concerns about the patient. This interview was recorded at the International Workshop on Non-Hodgkin Lymphoma (iwNHL) 2018 meeting, held in Nice, France.

Transcript (edited for clarity):

I do think that it’s very helpful to have a neurologist as part of the team that’s taking care of these patients. At our institution, the neurologists do a baseline exam just to become familiar with the patient: what the patient’s neurologic history is, if there is any prior history of seizures and then also I think to do some education. And this could be done by any clinician on the team and we follow the patients if they do develop neurotoxicity in the hospital.

Some patients are treated in the outpatient setting and then they come and see a provider every day and if they were to develop a seizure and neurologic symptoms then they’re admitted. Certainly, seizures can develop and movement disorders and weakness, so I think it’s important to have a neurologist who at least is starting to see these patients and becomes familiar. There’s a lot of pattern recognition and you become more comfortable, it’s nice to have someone to turn to help with this.

Certainly with the seizure management, the neurologist can be very helpful for that as well, but again I think that what we’ve found to be very helpful is just having a group of what we call “CAR-T super users” so, a close-knit team may be involved, someone from the intensive care unit, nursing, the providers who are seeing the patient on a daily basis that are really able to work together as a group and make each other aware if there are questions or concerns about the patient and of course also education as well.

So, we found that that’s very helpful and now really, if you do that, then it becomes a much more routine process and you become more comfortable guiding the patient through the process should there be any toxicity.

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