复发难治性弥漫性大B细胞淋巴瘤患者行CAR-T细胞免疫治疗的护理

Nursing management of patients with Chimeric Antigen Receptor T-Cell immunotherapy for relapsed and refractory diffuse large B-cell lymphoma

目的总结复发难治性弥漫性大B细胞淋巴瘤(DLBCL)患者的嵌合型抗原受体T细胞(CAR-T)免疫治疗的护理。方法选取血液科收治的复发难治性DLBCL患者12例,12例均证实存在CD19抗原表达,给予抗CD19嵌合抗原受体T细胞(CD19-CAR-T)注射液(NCT02976857,Cellular Biomedicine Group)治疗。护理内容包括预处理化的护理,抗CD19CAR-T细胞回输的护理,密切监测生命体征,严密观察出入量和生化、凝血功能等指标,心理治疗。结果经单疗程抗CD19CAR-T细胞治疗后,12例患者中3例完全缓解(CR),2例部分缓解(PR),3例疾病稳定(SD),4例患者治疗后持续疾病进展,最终死亡。结论护理人员应掌握CAR-T细胞免疫治疗的知识,采取针对性的护理措施,降低复发难治性DLBCL患者免疫治疗风险。

Objective To summarize the nursing management of patients with Chimeric Antigen Receptor T-Cell(CAR-T)immunotherapy for relapsed and refractory diffuse large B-cell lymphoma(DLBCL). Methods Totally 12 DLBCL patients with CD19 expression were given anti-CD19 CAR-T immunotherapy. During the treatment, The comprehensive nursing interventions included nursing of anti-CD19 CAR-T cell transfusion(NCT02976857,Cellular Biomedicine Group),vital sign monitoring, observation on biochemical indexes and coagulation function, psychological care, etc. Results Of 12 patients with single-course anti-CD19 CAR-Timmunotherapy, 3 cases with complete response, 2 cases with partial response, 3 cases with stable disease, and 4 cases of progressive disease. Conclusion It is required to improve the nurse' knowledge and awareness of CAR-T immunotherapy, and targeted nursing interventions should be carried to in to ensure the safety of DLBCL patients.