Defining and designing a remote monitoring tool for CAR T-cell therapy patients in Canada
Effective at-home monitoring of patients after CAR T-cell therapy requires that patients are able to easily report vital data and symptoms to physicians frequently, fast and reliably; and that physicians are able to respond to these data effectively.
The purpose of our capstone project is to prototype an app to monitor patients for parameters associated with potential adverse effects of CAR T-cell therapy, including cytokine release syndrome, neurotoxicity, and infection.
Background
Chimeric antigen receptor (CAR) T-cell therapy is a cell-based immunotherapy that utilizes genetically modified T-cells to combat cancer (National Cancer Institute, 2022). The standard therapies for treating blood cancers such as lymphocytic leukemias and lymphomas involve radiation, high-dose chemotherapy, and often autologous stem cell transplantation (National Cancer Institute, 2022). Having failed standard treatment, many patients become eligible for CAR T-cell therapy, which uses the patient’s genetically modified T-cells to destroy their leukemia or lymphoma (Cordeiro et al., 2020). Specifically, CD19-directed CAR T-cell therapy targets the CD19 antigen, a surface protein found in lymphatic malignancies with a B-cell phenotype (Cordeiro et al., 2020).
Side effects of this cellular treatment can be severe and include long-term B-cell deficiency, substantial neurotoxicity, and Cytokine Release Syndrome (CRS) (Mcnulty, 2022). CRS is an inflammatory response caused by infused CAR T-cells (Cordeiro et al., 2020). Upon their activation, T-cells release proinflammatory cytokines that can lead to multiorgan dysfunction, which has previously been described as sterile sepsis (Cordeiro et al., 2020). Immune effector cell-associated neurotoxicity syndrome (ICANS) is a type of toxic encephalopathy that may cause tremors, confusion, and dysgraphia, and develops in 20 to 70% of patients within a median of 4–6 days after CAR T-cell infusion (Tallantyre et al., 2020).
After CD19 CAR T-cell infusion, symptom monitoring (temperature, blood pressure, and cognitive function tests), blood count checks, and diagnostic imaging are used to track symptoms and side effects for 30 to 40 days (Los-Arcos et al., 2020). This monitoring involves frequent hospital visits, which is costly for both the patient and the healthcare provider, and significantly impacts the patient’s quality of life (Chacim et al., 2022). There is a need to improve the current process for follow-up care after CAR T-cell therapy to reduce the burden of follow-up on the patients, physicians, and healthcare system, ultimately improving patient outcomes.
The purpose of the project is to develop a mobile phone-based application that will allow patients who have received CD19-directed CAR T-cell therapy to easily report symptoms and enable real-time remote monitoring of these patients by physicians after patients are discharged from the hospital. This study will address the following research question: What elements and functionalities should be included in a mobile phone application to provide effective data collection and remote monitoring of CAR T-cell therapy patients after discharge from the hospital?
The objective of this research project is to gather input on app requirements and functionality from CAR T-cell therapy patients and physicians through:
- interviews with patients and physicians to inform app development, and
- a survey to gather feedback on the app prototype from patients and physicians.
Project team
- Amena Ali
- Shayna Kay
- Kelly Oyiliagu