Available online 4 March 2024, 151614

Author links open overlay panel, , , , , AbstractObjectives

Chimeric Antigen Receptor (CAR) T-cell treatment is associated with several unique toxicities, and the short-term symptom trajectory in the immediately after therapy is well-documented. However, little is known about patients’ long-term symptom experience. The study aimed to elicit the symptom experience of adult patients in remission after CAR T-cell therapy for B cell lymphoma.

Data Sources

A qualitative descriptive design with thematic analysis was utilized. Recruitment occurred at a tertiary academic medical center using the following inclusion criteria: adult recipient of CAR T-cell therapy for B-cell lymphoma between 3 and 12 months prior to enrollment, and currently in remission. Semi-structured interviews were conducted, transcripts were inductively coded, and team members met weekly to ensure rigor. The final sample included 10 patients: Seven received tisagenlecleucel and three received lisocabtagene marleucel and were a median of 169 days post-infusion and 65 years of age.

Conclusions

Participants continued to report symptoms, including fatigue, neuropathy, low endurance, insomnia, memory problems, and pain. Most symptoms improved over time. Some symptoms interfered with social activities, work, driving, and physical activity, though participants reported that most symptoms existed prior to CAR T-cell therapy, and overall, found CAR T-cell therapy acceptable.

Implications for Nursing Practice

Patients in remission after CAR T-cell therapy often continue to experience symptoms. Nurses should continue to assess this growing patient population and determine if patients require additional symptom management or support. Further research is needed to understand long-term symptom trajectory and associations with prior lines of therapy and CAR T-cell therapy.

Section snippetsDesign

A qualitative descriptive design was used with thematic analysis and inductive coding.8

Sampling and Recruitment

Patients treated with tisa-cel or liso-cel for relapsed/refractory large B-cell lymphoma (including diffuse large B-cell lymphoma, high-grade B-cell lymphoma, or diffuse large B-cell lymphoma arising from follicular lymphoma) were identified via the center's medical database and were consecutively approached for consent and participation via telephone using convenience sampling from May to September 2022.

For

Results

Of 16 eligible potential participants, 10 participants (62%) consented to participate and completed interviews. Of the 6 who declined to participate, 5 were nonresponders and 1 was not interested in the study. Participants were a median of 65 years of age (51 to 74 years), and the majority were male (70%), White (90%), and married or partnered (70%) (Table 1). Seven participants received tisa-cel, and three received liso-cel therapy. Participants were a median of 169 days postinfusion (113 to

Discussion

Our study with individuals in remission from B-cell lymphoma 3 to -12 months after tisa-cel or liso-cel CAR T-cell therapy finds most symptoms improved over time and are managed independently. However, all individuals reported some long-term symptoms that may interfere with aspects of socialization, employment, driving, and physical activity. Participants report ambiguity of their symptoms, with most unsure if symptoms are from prior disease and treatments, aging, or CAR T-cell therapy. Given

Limitations

The findings of this study should be interpreted in the context of the following limitations. Our study includes a small sample of CAR T-cell recipients, though the goal of this study is to enhance the breadth of patient experience information. Further, our consecutive sample was mostly White men with a college degree or higher, though with variation in annual household income and insurance status. Persons with differing education levels and ethnicities may have different experiences than those

CRediT authorship contribution statement

Lucy Andersen: Conceptualization, Data curation, Formal analysis, Funding acquisition, Investigation, Project administration, Writing – original draft. Kayla M. Baker: Data curation, Formal analysis, Investigation, Writing – original draft. Heather Difilippo: Data curation, Resources, Writing – review & editing. Salimah H. Meghani: Conceptualization, Methodology, Writing – review & editing. David Porter: Conceptualization, Data curation, Resources, Writing – review & editing. Jie Deng:

Declaration of competing interest

The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Lucy Andersen reports statistical analysis was provided by School of Nursing Doctoral Student Organization at the University of Pennsylvania. Lucy Andersen reports a relationship with Janssen Pharmaceuticals Inc that includes: employment. If there are other authors, they declare that they have no known competing financial interests or personal relationships that

Acknowledgments

The authors would like to thank the participants for their time and contributions to this study.

References (22)H Kim et al.Characteristics of qualitative descriptive studies: a systematic review

Res Nurs Health

(2017)

View full text

© 2024 Elsevier Inc. All rights reserved.