Multifaceted Roles of Nursing in the Care of Patients Receiving CAR T-cell Therapy for Pediatric Refractory or Relapsed Acute Lymphoblastic Leukemia

Pediatric acute lymphoblastic leukemia (ALL) is the most common cancer in children. Survival rates after initial diagnosis of ALL are quite high, however survival rates for patients with refractory or relapsed ALL remain poor despite intensive chemotherapy, indicating the need for novel therapies. Treatment for pediatric refractory and relapsed ALL has undergone a dramatic change over the past twelve years due to the success of targeted immunotherapy. In particular, chimeric antigen receptor-T (CAR-T) cell therapy has shown great promise in the treatment of pediatric refractory and relapsed ALL. Due to encouraging initial results, there are increasing numbers of trials utilizing this treatment. Patients and families have been given hope with the introduction and progress of this innovative therapy. Expert nursing care is crucial for successful patient outcomes. Nurses are integral to the management, care, and monitoring of CAR-T cell patients, ensuring study guidelines are followed and providing continuity. CAR-T cell therapy has the potential to cause severe toxicities. Therefore, nurses must be educated so that they can provide safe care and effectively educate patients and families regarding the associated risks. In this article we describe the CAR-T cell process and focus on the multiple roles of the nurse along with highlighting collaborative relationships with other disciplines.