Management of neurotoxicity syndrome complicated by autologous hematopoietic stem cell transplantation bridge to chimeric antigen receptor T-Cell therapy: A case report

Pingfang Jiang; Pan Yang; Weijuan Wang; Jialei Cao; Wei Chen; Jianhong Fu; Lin Lu; Yin Lu; Xiaming Zhu

doi:10.1016/j.apjon.2023.100368

Management of neurotoxicity syndrome complicated by autologous hematopoietic stem cell transplantation bridge to chimeric antigen receptor T-Cell therapy: A case report

Asia Pac J Oncol Nurs. 2023 Dec 27;11(3):100368. doi: 10.1016/j.apjon.2023.100368. eCollection 2024 Mar.

Authors

Pingfang Jiang^{1

2

3

4

5}, Pan Yang^{1

2

3

4

5

6}, Weijuan Wang^{1

2

3

4

5}, Jialei Cao^{1

2

3

4

5}, Wei Chen^{1

2

3

4

5}, Jianhong Fu^{1

2

3

4

5}, Lin Lu⁶, Yin Lu^{1

2

3

4

5}, Xiaming Zhu^{1

2

3

4

5}

Affiliations

¹ National Clinical Research Center for Hematologic Diseases, China.
² Department of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, China.
³ Hematopoietic Transplant Institute, Soochow University, Suzhou, China.
⁴ Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, China.
⁵ Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China.
⁶ Nursing College of Soochow University, Suzhou, China.

Abstract

Effectively addressing the challenges posed by relapsed and refractory diffuse large B-cell lymphoma, particularly when employing autologous hematopoietic stem cell transplantation and CAR-T therapy, requires a comprehensive approach to treatment and nursing. This case report emphasizes a nursing strategy focused on managing neurotoxicity post-CAR-T therapy. Nursing interventions include the identification of neurotoxicity symptoms, neuropsychiatric management, careful support during lumbar puncture and intrathecal administration, psychological assistance, and adaptive nutritional guidance. The diligent application of treatment and nursing care resulted in a remarkable recovery for the patient, as evidenced by the alleviation of central facial paralysis, improvement in swallowing function (from Grade 4 to Grade 2), and enhanced vocalization. Consistent and specialized nursing care is paramount for effectively managing complications, especially neurotoxicity, in patients undergoing CAR-T therapy. A thorough monitoring of symptoms and personalized care contribute to optimizing treatment outcomes and ensuring patient safety.

Keywords: Autologous hematopoietic stem cell transplantation; CAR-T cell immunotherapy; Case report; Neurotoxicity syndrome; Nursing.

Publication types

Case Reports