Idecabtagene Vicleucel
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Trade Name
Abecma (primary brand name); generic idecabtagene vicleucel
Classification
Chimeric Antigen Receptor (CAR) T-cell therapy; antineoplastic, immunotherapy
Dosage/Route
- * Dosage: Suspension of 300-510 × 10⁶ CAR-positive T-cells (customized per patient)
- * Route: Intravenous (IV) infusion
Usual Dosage
- * One-time dose: 300-510 × 10⁶ CAR-positive viable T-cells, infused after lymphodepleting chemotherapy (fludarabine and cyclophosphamide, typically 3 days prior)
- * Dose is patient-specific, based on body weight and T-cell count in the infusion bag(s)
Mechanism of Action
Autologous T-cells are genetically modified to express a CAR targeting B-cell maturation antigen (BCMA) on myeloma cells. Upon infusion, these T-cells bind BCMA, triggering an immune response that kills myeloma cells via cytotoxicity, slowing disease progression
Side Effects & Adverse Effects
- * Side Effects: Fatigue, fever, diarrhea, nausea, headache, musculoskeletal pain
- * Adverse Effects:
- – Cytokine Release Syndrome (CRS) (fever, hypotension, hypoxia; can be fatal)
- – Neurotoxicity (confusion, seizures, encephalopathy; may be severe)
- – Prolonged cytopenias (neutropenia, anemia, thrombocytopenia)
- – Infections, hypogammaglobulinemia, rare T-cell malignancies
Nursing Management (Implications & Teachings)
- * Implications:
- – Monitor for CRS (vital signs, oxygen saturation q4h during first week)
- – Assess for neurotoxicity (mental status, speech changes; use ICE score)
- – Administer premeds (acetaminophen, diphenhydramine) 30-60 min pre-infusion
- – Ensure tocilizumab available for CRS; avoid prophylactic steroids (impairs T-cell function)
- – Track labs: CBC, IgG levels (hypogammaglobulinemia risk)
- * Teachings:
- – Stay within 2 hours of facility for 4 weeks post-infusion
- – Report fever >100.4°F, confusion, breathing issues, or bleeding immediately
- – Avoid driving/tasks requiring alertness for 8 weeks (neuro risk)
- – Carry Patient Wallet Card for emergency ID of CAR T-cell therapy
Indication for This Patient
- * Relapsed/refractory multiple myeloma in adults after ≥2 prior therapies (including an immunomodulatory agent, proteasome inhibitor, and anti-CD38 antibody)
- * Used when disease progresses despite standard treatments
Time
- * Timing: Single IV infusion over 30 minutes per bag (1-2 bags), 2 days after lymphodepleting chemo
- * Monitoring: Daily checks for 7 days at facility; proximity to care for 4 weeks
- * Onset: Response may start in weeks, peak effect months later
