Pediatric Survivorship: Considerations Following CAR T-Cell Therapy

Colleen Callahan, MSN, CRNP; Amy Barry, MSN, CRNP; Stephanie Fooks-Parker, MSW, LSW, OSW-C; Laura Smith, MSN, CRNP; Diane Baniewicz, MSN, CRNP; Wendy Hobbie, MSN, CRNP, FAAN


Background: This article presents an overview of pediatric relapsed and refractory acute lymphoblastic leukemia (ALL) and chimeric antigen receptor (CAR) T-cell therapy in pediatric patients.

Objectives: Acute and chronic post–CAR T-cell effects and considerations are discussed, along with survivorship considerations.

Methods: A case study illustrates the identification and management of physiologic and psychosocial sequelae.

Findings: B-cell aplasia, hypogammaglobulinemia, infections, and cumulative effects of CAR T-cell therapy and other treatments are a concern in the pediatric population. Unique to pediatric and young adult survivors of childbearing potential are implications for post-treatment fertility. Financial toxicities and psychosocial needs require a family-centered approach to interventions that address the impact of CAR T-cell therapy not only on the patient, but also on caregivers and siblings.

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