Implementation of a lisocabtagene maraleucel chimeric antigen receptor T-cell therapy outpatient monitoring program: Multicenter nursing/advanced practice provider perspectives

Abstract

Objectives: Lisocabtagene maraleucel (liso-cel; Breyanzi), an autologous chimeric antigen receptor T-cell therapy, has demonstrated efficacy and safety in relapsed/refractory large B-cell lymphoma, chronic lymphocytic leukemia/small lymphocytic lymphoma, follicular lymphoma, and mantle cell lymphoma. Outpatient monitoring after liso-cel administration has shown lower health care resource utilization and cost and high patient satisfaction. However, outpatient monitoring programs require well-designed processes with collaborations from multiple stakeholders across several facilities. The study objective is to provide learnings and key considerations from nurses and advanced practice providers (APP) with experience setting up and managing liso-cel outpatient monitoring programs.

Data source: Author experience gathered from 3 institutions at 2 workshops.

Results: In the reviewed programs, patients are discharged on the same day after liso-cel infusion and observation. They are required to remain within a short distance of the facility for ≥4 weeks with admission to treatment facilities upon experiencing adverse events (AE). Nurses/APPs report several key features of successful programs: flexibility to carry out essential roles/functions based on institution's resources and staff structure, a phased or hybrid (hospital/clinic) approach to program launch, a core team to run and guide the program, robust training for staff, options to tailor AE monitoring based on institution guidelines, and coordinated transitions between multiple stakeholders and facilities.

Conclusions: Nurses/APPs are critical contributors to liso-cel outpatient monitoring programs. Success in providing appropriate, complex individualized care in these programs can be achieved by using a multistakeholder approach with appropriate staff and patient/caregiver training and careful coordination across multiple functions and facilities.

Implications for nursing practice: The learnings and resources presented may provide insight to considerations around the development of a cell therapy outpatient monitoring program. However, the information provided here should be taken together with other relevant resources and guidelines and should be adapted to align with the institution's own guidelines.

Keywords: Advanced practice provider; Breyanzi; Chimeric antigen receptor T-cell therapy; Lisocabtagene maraleucel; Nursing; Outpatient.