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Management of Severe Toxic Reaction of Immunotherapy in 1 patient with
Follicular Lymphoma

W. Zhang and Y. Cui 1
1

1
Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and
Peking Union Medical College, China

Background: Cytokine release syndrome (CRS) and Immune effector cell-associated neurotoxicity
syndrome (ICANS) is the most serious complication in lymphoma patients treated with bispecific
antibody.

Objective: To report the nursing and management that successfully control the onset of coincidence
of CRS and ICANS in one subject receiving a bispecific antibody treatment for Follicular Lymphoma.

Methods: Medical Chart was retrospectively reviewed and nursing of CRS and ICANS was summarized.

Results: A 50- year old male diagnosed with FL and enrolled in clinical trial of a bispecific antibody.
After medication, he had CRS and ICANS presented as hyperpyrexia, disturbance of consciousness,
unable to response to questions correctly, etc. Hyperpyrexia was managed with acetaminophen
and physical cooling treatment. Tocilizumab was used to control CRS; Dexamethasone was used
to control ICANS; Quetiapine fumarate was used as sedation treatment; Oxygen was given as support.
Nursing management for ICANS include fever control, ECG and vital signs monitor, evaluate the
conscious state. Nutritional supports care include light, easy to digest, high-calorie, vitamin-rich soft
food, maintain the function of body tissues and organs. Basic nursing care include ward ventilation,
maintain the appropriate room temperature and humidity. Indoor air disinfection was performed
twice a day. Safety nursing care include prevent accidents, a dynamic risk assessment of falling and
falling, hanging safety signs, safety education for patients’ families. Psychological nursing care include
guide family members to adjust their emotions, actively face the adverse reactions of patients, and
effectively cooperate with treatment and nursing. After the above treatment and nursing, the patient
return conscious, able to answer questions correctly, in good mental state, without fever and vomiting
symptoms, and ICE score was 10 points.

Conclusion: Appropriate nursing care is essential to rescue patients with CRS and ICANS after
bispecific antibody drugs treatment

Keywords: clinical trial, CRS, ICANS, bispecific antibody

_____________________________________________________________________________________________________
Poster Presentation Abstracts
Correspondence: Wang Zhang, Institute of Hematology and Blood Diseases Hospital, Chinese Acade-
my of Medical Sciences and Peking Union Medical College, China
E-mail: zhangwang@ihcams.ac.cn

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