scholarly journals Imagining the cell therapist: Future CAR T cell monitoring and intervention strategies to improve patient outcomes

eJHaem ◽  
2021 ◽  
Author(s):  
Michael D. Jain ◽  
Jay Y. Spiegel
Keyword(s):  
T Cell ◽  
Patient Outcomes ◽  
Intervention Strategies ◽  
Car T Cell ◽  
Car T ◽  
Cell Monitoring ◽  
Improve Patient

scholarly journals Chimeric Antigen Receptor T Cell Therapy Management and Safety: A Practical Tool From a Multidisciplinary Team Perspective

2021 ◽  
Vol 11 ◽  
Author(s):  
María Belen Marzal-Alfaro ◽  
Vicente Escudero-Vilaplana ◽  
Jose Luis Revuelta-Herrero ◽  
Roberto Collado-Borrell ◽  
Ana Herranz-Alonso ◽  
...  
Keyword(s):  
T Cell ◽  
Cell Therapy ◽  
Chimeric Antigen Receptor ◽  
Multidisciplinary Team ◽  
T Cell Therapy ◽  
Therapy Management ◽  
Car T Cell ◽  
Car T Cell Therapy ◽  
Car T ◽  
Improve Patient

PurposeThe use process for chimeric antigen receptor T (CAR-T) cell drugs is complex and has been associated with a number of potentially severe complications, which requires management by a multidisciplinary team. Pharmacists are a key element in the team and have roles and responsibilities. Our objective was to develop a structured and practical guide that supports hospital pharmacist responsibilities and defines specific activities in a CAR-T cell therapy program, specifically in Europe.MethodsA literature review was performed, and the recommendations related to pharmacy practice in CAR-T therapy programs were analyzed. A multidisciplinary team was assembled, and meetings were held to address the key tasks in the CAR-T cells’ management process and to create the guide, based on national and international recommendations and in expert’s opinions.ResultsThe multidisciplinary team defined the following key tasks and issued recommendations to improve patient safety, treatment efficacy, and quality: patient selection and evaluation, CAR-T cell drug order to manufacturer, apheresis and material shipment, reception of CAR-T cell drug and storing, CAR-T cell drug prescription and pharmacy verification, CAR-T cell drug thawing and dispensing, CAR-T cell drug administration, patient education, pharmacovigilance and monitoring and outcomes’ record and evaluation. In each task the pharmacist’s role and how it can improve patient care are defined. A checklist was created to guarantee the compliance of standard operating procedures approved in the institution to manage CAR-T cell therapy and as a tool to collect required data for outcomes’ record and evaluation.ConclusionThis article provides a consensus set of safety recommendations regarding CAR-T therapy management in clinical practice, easily implementable by other institutions in the European setting. The guide identifies key steps where the involvement of hospital pharmacists would improve the safety and quality of the process and is a support guide to standardize hospital pharmacists’ responsibilities within the multidisciplinary team.

scholarly journals Modelling CAR T-cell Therapy with Patient Preconditioning

2020 ◽  
Author(s):  
Katherine Owens ◽  
Ivana Bozic
Keyword(s):  
T Cells ◽  
T Cell ◽  
Cell Therapy ◽  
Patient Outcomes ◽  
T Cell Therapy ◽  
Car T Cells ◽  
Cell Dose ◽  
Car T Cell ◽  
Car T Cell Therapy ◽  
Car T

AbstractThe Federal Drug Administration (FDA) approved the first Chimeric Antigen Receptor T-cell (CAR T-cell) therapies for the treatment of several blood cancers in 2017, and efforts are underway to broaden CAR T technology to address other cancer types. Standard treatment protocols incorporate a preconditioning regimen of lymphodepleting chemotherapy prior to CAR T-cell infusion. However, the connection between preconditioning regimens and patient outcomes is still not fully understood. Optimizing patient preconditioning plans and reducing the CAR T-cell dose necessary for achieving remission could make therapy safer. In this paper, we test treatment regimens consisting of sequential administration of chemotherapy and CAR T-cell therapy on a system of differential equations that models the tumor-immune interaction. We use numerical simulations of treatment plans from within the scope of current medical practice to assess the effect of preconditioning plans on the success of CAR T-cell therapy. Model results affirm clinical observations that preconditioning can be crucial for some patients, not just to reduce side effects, but to even achieve remission at all. We demonstrate that preconditioning plans using the same CAR T-cell dose and the same total concentration of chemotherapy can lead to different patient outcomes due to different delivery schedules. Results from sensitivity analysis of the model parameters suggest that making small improvements in the effectiveness of CAR T-cells in attacking cancer cells, rather than targeting the recruitment and longevity of CAR T-cells, will significantly reduce the minimum dose required for successful treatment. Our modeling framework represents a starting point for evaluating the efficacy of patient preconditioning in the context of CAR T-cell therapy.

Challenges and optimization of CAR-T cell therapy

2021 ◽  
Author(s):  
Mei Luo ◽  
Hongchang Zhang ◽  
Linnan Zhu ◽  
Qumiao Xu ◽  
Qianqian Gao
Keyword(s):  
T Cell ◽  
Cell Therapy ◽  
T Cell Therapy ◽  
Car T Cell ◽  
Car T Cell Therapy ◽  
Car T
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