Remote monitoring of CAR T-cell treated patients by a specialized nurse to detect and manage late complications: report of the CARAMA program

Background CAR T-cells have been approved for the treatment of relapsed/refractory (R/R) diffuse large B-cell lymphoma (DLBCL), mantle cell lymphoma (MCL), follicular lymphoma (FL), acute lymphoblastic leukemia (ALL), and multiple myeloma (MM). Although acute toxicities of CAR T-cells are well handled during hospitalization, delayed complications, including cytopenias, infections and relapses, are more challenging to manage after hospital discharge. To address this issue, a specific program (CARAMA) was initiated in Rennes University Hospital consisting in remote monitoring of CAR T-cell recipients by a specialized nurse. Methods Patients treated with CAR T-cells were followed remotely by a CARAMA nurse after hospital discharge. Adverse events and interventions were prospectively collected by the CARAMA nurse who called patients daily until day 21, twice a week until day 28, once a week until month 2, every other week until month 3, once a month until month 6, and once every 3 months until month 12 or until relapse/progression. Results Between September 2019 and December 2022, the program enrolled 150 patients with a median age of 64 years (range, 16-80). Patients received a median of 15 calls (range, 0-41). The CARAMA nurse recorded complications including cytopenias (111 patients, 73.5%) with transfusion (44 patients, 29.1%) and/or growth factor (110 patients, 72.8%) requirements, and infections in need of antibiotics (37 patients, 24.5%). Disease relapse was detected within CARAMA before a planned medical consultation in 24/65 patients (36.9%). The CARAMA nurse referred 75 patients (49.7%) to their general practitioner (N=71), hematologist (N=24) and/or other physician (N=29) and requested hospitalization for 41 patients (27.2%), due to infection (48.8%), profound cytopenias (14.6%), disease relapse (17.1%), and/or other causes (19.5%). Supportive measures were organized for 63 patients (41.7%). A survey at 3 months of the CARAMA program confirmed the high level of patient satisfaction. Conclusions Remote monitoring of patients treated with CAR T-cells, by a specialized dedicated nurse, allows early detection and management of delayed complications. It also saves medical time and resources. Finally, this close follow-up is reassuring for the patients and contributes to their well-being. These results support the development of CARAMA nurses in CAR T-cell centers.