Nursing analyses and procedures for patients with neurotoxicities arising from Chimeric Antigen Receptor (CAR) T-Cell Immunotherapy: A systematic review
DOI:
https://doi.org/10.33448/rsd-v14i9.49533Keywords:
Nursing, Nursing Care, Chimeric Antigen Receptor Therapy, CAR T Cells Therapy, Neurotoxicity Syndromes.Abstract
CAR-T immunotherapy represents an innovative revolution in the treatment of hematological malignancies, although its success is counterbalanced by a unique and potentially fatal neurotoxicity profile, notably Cytokine Release Syndrome (CRS) and Immune Effector Cell-Associated Neurotoxicity Syndrome (ICANS). The objective was to systematically synthesize and analyze the scientific evidence concerning nursing procedures and interventions for the monitoring, assessment, and management of adverse effects in patients presenting with neurotoxicities associated with CAR-T immunotherapy. A systematic review was conducted following the PRISMA2020 guidelines, with a narrative synthesis guided by the SWiM (Synthesis Without Meta-Analysis) guideline, and Bardin's Content Analysis was performed. The searches were carried out in the PubMed, Web of Science, Scopus, Embase, and VHL databases. After applying inclusion and exclusion criteria, 44 documents were used in this review. The research demonstrates that specialized nursing is fundamental to patient safety, acting in the early detection of neurotoxicities through rigorous monitoring and the application of standardized tools, such as the ICE score for neurological assessment. Nursing interventions range from supportive care to the administration of rescue therapies, such as Tocilizumab and Corticosteroids, and the escalation of care to the ICU. Beyond the acute phase, the role of nursing is vital in managing late complications, such as Hypogammaglobulinemia and B-Cell Aplasia, by coordinating survivorship plans and patient education. The conclusion reinforces that Advanced Practice Nursing is an indispensable component to mitigate morbidity and mortality, aiming to ensure the success of CAR-T immunotherapy.
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Copyright (c) 2025 Leandro Maia Leão, Moisés Davi da Silva Bomfim, Uirassú Tupinambá Silva de Lima, Ednólia Nobre Lopes de Lima, Ellen Aline Moya Nicolau Pieper, Ticiane Rosa de Carvalho Costa, Kleytonn Giann Silva de Santana, Dallyne Rebeca Santos Tojal, Sofia Vieira da Costa, Lucas dos Santos Santana, Luciana da Silva Viana
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