Honing the safety and delivery of CAR T-cell therapy

Chimeric antigen receptor (CAR) T-cell therapy is an emerging and evolving therapy for haematological malignancies, with the potential for broader use for other malignancies and autoimmune conditions. Although this therapy is now standard of care in many countries for B-cell non-Hodgkin lymphoma, the clinical delivery of this therapy continues to be refined, as its clinical application catches up to the impressive underlying science. In this thesis I present three projects on the theme of improving the clinical delivery of CAR T-cell therapy for B-cell non-Hodgkin lymphoma. The first project is a a clinical audit report including a new audit tool for reviewing nursing assessments of cytokine release syndrome and immune effector cell neurotoxicity syndrome, two of the primary characteristic risks seen after CAR T-cell therapy. The second study, RE-TELL, is a qualitative research study of Aotearoa New Zealand CAR T-cell patients, support persons, clinicians and administrators, to identify future improvements in CAR T-cell delivery. Lastly, I present THERMAL, a study of wearable temperature monitors for the detection of neutropenic fevers, a key risk with CAR T-cell therapy. These three projects represent attempts to enhance the safe clinical delivery of CAR T-cell therapy for B-cell non-Hodgkin lymphoma, from the patient level to the service design level, which could be readily translated into CAR T-cell service delivery in the future, both in Aotearoa New Zealand and internationally.