TABLE I.

Caveats for care of the patient on the chimeric antigen receptor (CAR) T cell therapy journey

Anticipate need: collect early in the disease course.

Be aware of chemotherapy and immunotherapy washout periods. Steroids affect normal T lymphocyte number and function, which are the starting product for manufacturing.

After allogeneic transplant, the new T cell population will be the starting product for manufacturing.

Avoid collecting T cells in the presence of high circulating blast counts.

During bridging chemotherapy, the goal is not to achieve remission, but rather to temporize.

Cytokine release syndrome can come on swiftly and later; careful monitoring by trained care-team members, who include members of the emergency room and critical care teams, is essential.

Have established care plans for management of severe cytokine release syndrome and neurologic toxicity.

Avoid steroids after CAR-T infusion unless cytokine release syndrome is established.