CAR T-Cell Therapy Offers Cancer Patients ‘Second Chance at Life’

There have been tremendous advances in cancer research and therapies over the last few years, and Brigham Health nurses are at the forefront of these efforts.

Dana-Farber/Brigham and Women’s Cancer Center (DF/BWCC) was one of the first centers in the nation to offer FDA-approved CAR T-Cell therapies for patients with some forms of lymphoma that did not respond to other treatments.

“CAR T-cell therapy is unlike anything we’ve done before,” said Daria Mlynarski, BSN, RN, OCN, of the Hematology/Oncology/Bone Marrow Transplant unit. “Many patients who are on track for hospice care have received a second chance at life with this treatment. It amazes me every time a patient comes back for a scan and we see the tumors shrinking until they are gone.”

Deb Moody, BSN, RN, OCN, of the Hematology/Oncology/Bone Marrow Transplant unit, agreed. “We have been caring for some of these patients for years, and this was truly their last hope. It’s incredible to see patients who had a terminal disease in remission after CAR T-cell therapy.”

The process involves taking a patient’s T cells and sending them to a laboratory where they are genetically engineered to express chimeric antigen receptors (CARs). When these are placed back into the patient through infusion (via a central line), the receptors help the patient’s T cells find and destroy cancer cells.

Oncology nurses administer infusions and provide the specialized care that patients require afterward. The therapy’s most common side effects are neurotoxicity and cytokine release syndrome, a systemic inflammatory response.

“Nurses are constantly monitoring patients and watching for signs of side effects,” said Mlynarski. “We are typically the first to identify them and alert the other care team members.”

Oncology staff collaborated with nurses and staff from the Emergency Department and the Neurosciences Intensive Care Unit who may also care for CAR T-cell therapy patients experiencing cytokine release syndrome and neurotoxicity.

It’s difficult for families to watch as patients develop these side effects, which can resemble a stroke and last for weeks. “Nurses play an important role in supporting families and reassuring them that this is usually temporary. It’s hard to believe that it will pass, but most patients do come out of it,” said Mlynarski.

The strong bonds that nurses develop with cancer patients and their families is one of the reasons Mlynarski has dedicated almost her entire 19-year nursing career to oncology.

“Cancer is a family disease, and you support the patients and families for a long time. You see them celebrate kids’ birthdays and share holidays because they’re usually in the hospital more than at home,” she said.

With so many advances in research, Dana-Farber/Brigham and Women’s Cancer Center nurses participate in clinical trials and offer new investigational treatments—and hope—to patients and families.

“To see so many cancer patients and their loved ones benefiting from new therapies is truly uplifting,” said Moody, who has worked in oncology at the Brigham for 21 years. “It’s unbelievable how far we have come in the last few decades."