Beyond CRS and ICANS: CAR T-cell Therapy for CNS Tumors: Nursing Assessment and Management-Beyond CRS and ICANS: CAR T-cell Therapy for CNS Tumors: Nursing Assessment and Management

Beyond CRS and ICANS: CAR T-cell Therapy for CNS Tumors: Nursing Assessment and Management

Video Transcription

Video Summary

The transcript describes a Stanford/UC Davis team’s CAR-T cell therapy trial for children and young adults with diffuse midline glioma (DMG), including DIPG and spinal tumors with the H3K27M mutation. The presenters explain how CAR-T cells are collected, reprogrammed, and infused either intravenously or directly into the cerebrospinal fluid via an Omaya or RICM reservoir. The trial evolved through multiple amendments, increasing doses over time and adjusting lymphodepleting chemotherapy schedules to improve outcomes while reducing toxicity.<br /><br />A major focus is nursing assessment and toxicity management. Key complications include tumor inflammation-associated neurotoxicity (TN), fever, seizures, hyponatremia, nausea, and clotting/bleeding risks. Management strategies include frequent neuro exams, CSF drainage, steroids, hypertonic saline, anakinra, Keppra prophylaxis, infection workups, and supportive care. <br /><br />The team also emphasizes intensive care coordination for families traveling from across the country, including imaging, lab monitoring, psychosocial support, child life services, and travel assistance.<br /><br />Early results are encouraging: among the first 11 patients reported in Nature Medicine, four had major tumor reduction, one had a complete response, and most had neurological improvement. A case example showed dramatic functional recovery after CAR-T therapy, highlighting the importance of celebrating “small wins” such as improved walking, speech, or quality of life.

Keywords

CAR-T cell therapy

diffuse midline glioma

DIPG

H3K27M mutation

neurotoxicity management

Omaya reservoir

lymphodepleting chemotherapy

pediatric oncology