Öz
Amaç
Kimerik antijen reseptörü (CAR)-T hücre tedavisi son yıllarda kullanılmaya başlanan ve hızlı gelişim gösteren yeni bir immünoterapi yaklaşımıdır. Bir immünoterapi tedavisi olarak kullanılan CAR-T hücreleri ise tümör hücresini hem direkt olarak hem de sitokin salınımını artırma yoluyla yok etmektedirler. Bu çalışmada amacımız, sitokin salınım sendromu (CRS) ve CAR-T ilişkili ensefelopati sendromu (CRES) yönetimi doğrultusunda, kliniğimizde yatarak CAR-T hücre tedavisi yapılan hastaları değerlendirmek ve ortaya çıkan CAR-T hücre tedavi sonrası toksisitelerinin yönetiminde uyguladığımız hemşirelik girişimlerini paylaşarak klinik uygulamalara rehberlik edebilmektir.
Yöntemler
Tanımlayıcı nitelikte olan bu çalışmaya 2020-2023 yılları arasında CAR-T hücre tedavisi yapılan 13 hasta dahil edildi. CAR-T hücre infüzyonunu takip eden dokuz günlük takip süreci hastaların dosyasından retrospektif olarak incelendi. CAR-T hücre infüzyonu sonrası ortaya çıkabilen CRS toksisite bulguları, CRES toksisite bulguları ve CARTOX-10 nörolojik değerlendirme formuna kayıt edilen bilişsel bulgular ile uygulanan tedavi yöntemleri değerlendirilerek kayıt edildi.
Bulgular
CAR-T hücre infüzyonu toksisite bulgularını değerlendirdiğimizde hastaların %38,46’sında CRS evre 1, %30,79’unda CRES evre 2, %15,38’inde disgrafi, %23,07’sinde bilişsel durumda bozulma, %7,69’unda somnolans, %7,69’unda kol ve omuz kaslarında kasılma geliştiği saptandı. İki hastanın ise hem CRS hem de CRES toksisite bulguları nedeniyle yoğun bakım ünitesine transfer edildiği belirlendi.
Sonuç
Yeni bir tedavi seçeneği olan CAR-T hücre infüzyonu sonrası toksisite takibi ve yönetiminde, hastanın klinik durum değişikliklerini belirlemede, hastanın bakımında ve bu konuda bilgi tabanını genişletmede hemşirelerin rolü önemlidir.
Anahtar Kelimeler: CAR-T hücre tedavisi, hematoloji, immünoterapi, hemşirelik
Kaynakça
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