Development of a Core Set of Patient- and Caregiver-Reported Signs and Symptoms to Facilitate Early Recognition of Acute Chimeric Antigen Receptor T-Cell Therapy Toxicities. Issue 3 (12th December 2022)

• Record Type: Journal Article
• Authors: Spanjaart, Anne M.; Pennings, Elise R.A.; Kos, Milan; Mutsaers, Pim G.N.J.; Lugtenburg, Pieternella J.; van Meerten, Tom; van Doesum, Jaap A.; Minnema, Monique C.; Jak, Margot; van Dorp, Suzanne; Vermaat, Joost S.P.; van der Poel, Marjolein W.M.; van Oijen, Martijn G.H.; Kuipers, Maria T.; Nijhof, Inger S.; Kersten, Marie José
• Is Part Of: JCO oncology practice. Volume 19:Issue 3(2023)
• Page Start: e407
• Page End: e416
• Publication Date: 2022-12-12
• Subjects: Oncology -- Periodicals; Medical Oncology; Neoplasms; Oncology; Periodicals; 616.994
• DOI: 10.1200/OP.22.00501
• Languages: English
• ISSNs: 2688-1527

Abstract

Abstract : PURPOSE: Prompt recognition of acute chimeric antigen receptor T (CAR T)-cell–mediated toxicities is crucial because adequate and timely management can prevent or reverse potential life-threatening complications. In the outpatient setting, patients and informal caregivers have to recognize and report signs and symptoms marking these acute toxicities. This study provides a core set of patient- and caregiver-reported signs and symptoms (outcomes, P/CROs) and definitions of red flags warranting immediate action to include in a daily checklist for support at home, with the goal to make outpatient post–CAR T-cell care safer, optimize patient and caregiver support, and thereby facilitating an early discharge/hospital visit reduction strategy. METHODS: We performed a systematic review of phase II/III trials of US Food and Drug Administration–approved CAR T-cell products and selected all common and severe adverse events that could be translated into a P/CRO for inclusion in a two-round modified Delphi procedure. Eleven CAR T-cell–dedicated hematologists from the Dutch CAR T-cell tumorboard representing all treating centers selected P/CROs for inclusion in the core set and defined red flags. The final core set was evaluated with patients and caregivers. RESULTS: From nine clinical trials, 457 adverse events were identified of which 42 could be used as P/CRO. The final core set contains 28 items, including five signs for measurement via wearables and two signs for caregiver-performed assessments. CONCLUSION: This study provides a core set of P/CROs that can serve as a framework for (eHealth) tools that aim to enable patients and caregivers to more effectively recognize and report signs and symptoms of acute toxicities after CAR T-cell therapy, which will enhance safe outpatient treatment monitoring.