Considerations for Patient Monitoring Following CAR T and Bispecific Administration: Amir Fathi, MD

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Post-treatment monitoring for patients receiving advanced immunotherapies, such as chimeric antigen receptor T cells (CAR T) and bispecific antibodies, share some common ground with traditional chemotherapy, but also present crucial differences, explained Amir Fathi, MD, leukemia specialist and academic oncologist at Massachusetts General Hospital. Whereas standard practices involve monitoring blood counts, vital signs, and physical exam symptoms across all treatment types, CAR T and bispecific therapies necessitate a more specialized vigilance due to their unique adverse event profiles.

Some of these key distinct toxicities include the following:

• Cytokine release syndrome, which can manifest vaguely with disturbances in vitals like blood pressure and fevers, but can rapidly escalate into respiratory ailments, potentially requiring critical care; death is a possibility, but a rare outcome.
• Neurotoxicity symptoms, which can range from mild headaches to more severe issues such as aphasia, obtundation (decreased alertness/consciousness), seizures, and in rare cases, death.

Additionally, emerging CAR T products for myeloid malignancies, such as acute myeloid leukemia (AML), may cause profound blood count suppression, differing in pattern and severity from what is seen with conventional chemotherapy. Given these distinct risks, extensive patient and family education is paramount. For example, Fathi explained that patients receiving treatments such as blinatumomab (Blincyto; Amgen)—which is standard of care for AML—are thoroughly informed about these unique toxicities, including their diverse manifestations. It is critical for patients and their families to understand that any subtle changes in thinking, neurologic symptoms, general functioning, or vital disturbances (eg, falling blood pressure, fevers), he underscored, must not be ignored. Further, Fathi emphasized that reporting even a persistent headache or observations from family members that a patient seems confused or is not recalling things well is important.

The onus of vigilance extends beyond the care provider, however; patients and their families play a vital role in self-advocacy, ensuring prompt communication with their medical team if any concerning symptoms arise. This proactive approach allows for timely hospitalization and appropriate management, which is essential for patient safety.