Dr Stephen Schuster on Institution Commitments to Deliver CAR T Therapies

Deciding to administer CAR T-cell therapies is an institutional commitment that requires educating all clinicians who will be involved and partnerships with other organizations, said Stephen Schuster, MD, of the Perelman School of Medicine.

What education efforts are needed for patients and clinicians when new treatments like CAR T therapies first emerge?
It’s an institutional commitment if one is going to do CAR T-cell therapy; it’s not just a single physician or physician’s office. It involves multiple people, there’s a chain of people that are involved from the blood bank or transfusion service that receives the cells and thaws the cells and administers the cells to the physicians and nurse practitioners and nurses that are caring for the patients during infusion and after infusion of the cells.

And those people need to be educated not only in the specific adverse events of special interest—cytokine release, neurotoxicity—but also in terms of handling the cells and making sure that the patient is in the proper environment for surveillance for subsequent syndromes, either as an outpatient or an inpatient, depending on the product used. Most leukemia patients, kids, will be admitted to the hospital.

So, what’s helpful is the sponsors of the 2 products that have a commercial label, that’s tisagenlecleucel or Kymriah, and the other one is axicabtagene ciloleucel, which is called Yescarta, they have REMS [Risk Evaluation and Mitigation Strategy] programs. So, these are programs that will educate people at all points in the chain on what to expect, what the roles are, what the proper responses are and actually have a test and things like that. And that’s the first step in getting educated.

Obviously, experience is important and the only way you can get that is by doing it. I think that people who are new to it, in addition to the REMS programs, should probably have a relationship with someone who is experienced, so if they run into problems they have somebody they can call and bounce problems off of.
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