Creating a CAR-T Cell Presentation Tool for the Emergency Room

Topic Significance & Study Purpose/Background/Rationale Chimeric antigen receptor T cell (CAR-T cell) therapy has become a promising treatment for children with acute lymphoblastic leukaemia (ALL) and Non-Hodgkin lymphoma (NHL). Cytokine release syndrome (CRS) and Immune effector cell associated neurotoxicity syndrome (ICANS) are well-documented serious side-effects of CAR-T cell therapy, and early recognition, intervention and aggressive supportive therapy is paramount. Tociluzimab is the mainstay of treatment for moderate to severe CRS, with early administration essential. Corticosteroids should be reserved for life-threatening CRS or ICANS as their use may negate CAR-T cell activity. Emergency rooms (ER) are frontline in the assessment, escalation and treatment of CAR-T cell side effects. In establishing our CAR-T cell program, we have established a robust multi-disciplinary education approach and identified key a visual tool for prompt identification of these patients on presenting to the ER. Methods, Intervention, & Analysis Alongside multi-disciplinary training, we have devised a credit card sized tool for parents/carers to present to the ER triage on arrival, creating a visual prompt for their care. The card details that the child has recently received CAR-T cells and outlines the risk of CRS and ICANS. It highlights the location of guidelines on the hospital electronic information system and most importantly alerts ER staff against the administration of corticosteroids, unless previously discussed with the transplant and cellular therapy (TCT) team. The card is orange in color depicting the ‘triage level’ of half an hour for medical review. It will be given to all parents/carers once their child has received CAR-T cells. Findings & Interpretation We hope to present preliminary results soon, relating to the ER staff experience, patient's journey and outcomes. Discussion & Implications It is vital that children with CRS and ICANS are triaged efficiently and treated promptly on admission to hospital. We have devised a tool to help expedite their journey through the ER in a safe manner. Alongside electronic medical record alerts, we foresee this tool will assist in the provision of high-quality, targeted therapy to minimize potentially reversible, life-threatening toxicities.