嵌合抗原受体T细胞(CAR-T)免疫治疗难治性急性淋巴细胞白血病的护理

Exploration of integrated nursing care on CAR-T cell immunotherapy for refractory acute lymphocytic leukemia

目的探讨嵌合抗原受体T细胞(CAR-T)免疫治疗难治性B细胞急性淋巴细胞白血病(B-ALL)的临床效果与整体护理措施。方法在2名接受CAR-T细胞治疗的难治性B-ALL患者的医疗过程中,制定并实施相应的整套护理流程,包括设计《护理观察表》,着重加强对患者预处理的护理,CAR-T细胞回输的护理,肿瘤溶解综合征(TLS)的护理,细胞因子释放综合征(CRS)的观察与护理,同时采取心理护理等措施。结果 2名ALL患者经过CAR-T细胞治疗的精心医治以及整体护理,避免了TLS的发生,成功控制了CRS,帮助患者克服了恐惧心理,顺利度过观察期,最后经过骨髓复查提示完全缓解,顺利出院。结论通过对接受CAR-T细胞治疗的患者的整体护理,特别是在对其可能产生的各种并发症的系统治疗过程中的护理,可使CAR-T治疗的风险最小化。

Objective To discuss the clinical outcomes and overall nursing interventions in patients with refractory B cell acute lymphoblast leukemia （B-ALL） who received CAR-T cell immunotherapy. Methods The medical treatments and nursing processes, especially the whole nursing care application, before and after transfusion of CAR-T ceils, were analyzed in two refractory B-ALL cases which received CAR-T cell therapy. Results With the transfusion of CAR-T cell immunotherapy, tumor lysis syndrome （TLS） and cytokine release syndrome （CRS） were not observed. In addition, patients were assisted to overcome their own fear of cancer and successfully underwent the observation period. Lastly, the patients were discharged from hospital with complete remission （CR）. Conclusion It is reported that CAR-T cell therapy has positive clinical efficacy for refractory B-ALL patients. Our department takes the initiative to apply this therapy for refractory-relapsed B- ALL in southwest China, especially in Chongqing prefecture. The risk of CAR-T cell therapy was minimized, while the clini- cal outcomes were maximized by integrated nursing in patient care. Employing systematic treatment and integrated nursing care for patients treated with CAR-T therapies is valuable to minimize the complications which may be caused by CAR-T infusion.