Turkiye Klinikleri Journal of Nursing Sciences

.: REVIEW
CAR-T Hücre Tedavisinde Hemşirelik Yönetimi
Nursing Management in CAR-T Cell Therapy
Kadriye SAYIN KASARa, Yasemin YILDIRIMb
aAksaray Üniversitesi Sağlık Bilimleri Fakültesi, Hemşirelik Bölümü, Aksaray, TÜRKİYE
bEge Üniversitesi Hemşirelik Fakültesi, İç Hastalıkları Hemşireliği ABD, İzmir, TÜRKİYE
Turkiye Klinikleri J Nurs Sci. 2020;12(2):272-9
doi: 10.5336/nurses.2019-72274
Article Language: TR
Full Text
ÖZET
 Günümüzde hızla gelişmekte olan immünoterapi tedavilerinden biri de son yıllarda gelişimi hızlanan kimerik antijen reseptörü [chimeric antigen receptor (CAR)] T hücre tedavisidir. CAR-T hücreleri, genetik olarak tasarlanmış yapay T hücresi reseptörleri, tümör antijenlerinin tanınmasını sağlar. Teorik olarak, bu modifiye edilmiş hücreler, herhangi bir antijene karşı yönlendirilebilmekte ve hedef tümör hücrelerini öldürme yeteneğini artırabilmektedir. CAR-T hücre tedavisinin uygulanması, hücre üretimi, aferez ürünlerinin takibi, taşınması ve ciddi toksisitelerin yönetimini içeren karmaşık bir süreci içerir. CART hücre tedavisinin başarısı genel olarak, uygulamayı yapan ve bakım veren sağlık personelinin eğitimli olması ile kurumun toksisitelerinin yönetebilecek yeterli altyapıya sahip olmasına bağlıdır. Klinik hemşirelerinin toksisite semptomlarını tanıma ve tedavinin etkin olarak ilerlemesini desteklemek için yeni tedavi yöntemleri konusunda eğitilmesi ve bu konuda farkındalık oluşturulması önemlidir. Yaygın görülen toksisiteler; sitokin salınım sendromu, CAR-T hücre tedavisi ile ilişkili ensefalopati sendromu'dur. Bu çalışmada, CAR-T hücre tedavisinin başarılı bir şekilde uygulanabilmesi için tedavinin içeriği ve hemşirelik yönetimi açıklanmıştır. Hemşirelik yönetimi genel olarak; infüzyon süreci yönetimi, komplikasyonların yönetimi ve hasta eğitimi başlığı altında ele alınmıştır.

Anahtar Kelimeler: İmmünoterapi; CD19 antijen; hemşirelik bakımı
ABSTRACT
 One of the rapidly developing immunotherapy therapies is chimeric antigen receptor (CAR) T cell therapy which has been accelerating in recent years. CAR-T cells, genetically engineered artificial T cell receptors, allow the recognition of tumor antigens. Theoretically, these modified cells can be directed against any antigen and increase the ability to kill target tumor cells. CAR-T cell therapy involves a complex process involving cell production, tracking, transport of apheresis products, and management of serious toxicities. The success of CAR-T cell therapy generally depends on the fact that the health personnel performing the care and the care given are trained and the institution has sufficient infrastructure to manage the toxicities. It is important that clinical nurses are trained and raised awareness of new treatment methods to recognize the symptoms of toxicity and to support the effective progress of treatment. Common toxicities are cytokine release syndrome, CAR-T cell therapy-associated encephalopathy syndrome. In this review, the content of the treatment and nursing management are explained for the successful implementation of CAR-T cell therapy. Nursing management in general; infusion process management, complications management and patient education.

Keywords: Immunotherapy; CD19 antigens; nursing care
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