Telemedicine Blood Pressure Monitoring after anti-GD2 Monoclonal Antibody Immunotherapy During the COVID-19 Pandemic

Background and Aims: Anti GD2 immunotherapy is an essential component of treatment for high risk neuroblastoma Naxitamab, formerly known as hu3F8, is an anti GD2 immunotherapy that is given in the outpatient setting to patients with high risk neuroblastoma Potential adverse events include hypertension and Posterior Reversible Encephalopathy Syndrome (PRES), the latter associated with an acute rise in blood pressure (BP) Patients typically receive naxitamab Mon-Wed-Fri and if asymptomatic, are evaluated in the outpatient clinic 72 hours later for early signs of PRES including symptoms of lethargy, headaches, change in vision, change in behavior, and BP measurement The Covid-19 pandemic, with exceptionally high infection and death statistics in the epicenter of New York City has forced social distancing and minimizing visits to hospital Methods: With financial support from a non-profit organization we were able to rapidly coordinate a distribution of pediatric automated blood pressure machines and appropriate pediatric-sized cuffs Blood pressure machines were calibrated in clinic and families were taught how to use them prior to discharge with clear instructions to call if the patient experienced any symptoms of PRES Home blood pressure readings were obtained by family members 72 hours after completion of immunotherapy and a telemedicine visit was coordinated at that time to assess PRES symptoms Results: Together with telemedicine set up at MSKCC during the surge of the COVID-19 pandemic, this BP program was seamlessly piloted with full acceptance from the staff and families Patients thus far discharged home with blood pressure machines and telemedicine visits have not shown any adverse events including hypertension or signs of PRES This program maximizes patient safety, protocol compliance while minimizing travel, expense, and risk of COVID-19 exposure Conclusions: During the unforeseen pandemic we were able to utilize technology with the help of philanthropy to improvise and achieve optimal post-immunotherapy monitoring as well as appropriate Covid-19 isolation