'ZOOMing' in on Consulting with Children and Parents Remotely to Co-Create Health Information Resources.

The COVID-19 pandemic altered the way many people worked. Remote and creative ways were favoured and utilised for consultation activities. In this paper, we draw attention to how we have used creative methods over the teleconferencing platform 'ZOOM' to consult with children and their parents when we were unable to consult with them face-to-face. We document a clear timeline of how we have worked together to co-create an animation and information sheet about receiving outpatient parenteral antimicrobial therapy (OPAT). We identify the opportunities and challenges we faced.

SYMPTOM BURDEN, SYMPTOM MANAGEMENT, AND SUPPORTIVE CARE NEEDS AMONG TISA-CEL AND LISO-CEL CAR T-CELL PATIENTS IN REMISSION: A QUALITATIVE STUDY

purpose was to explore the symptoms and supportive care needs experienced by patients in remission after tisa-cel or liso-cel chimeric antigen receptor (CAR) T-cell therapy. Though CAR T-cell therapy is expanding in application to various types of cancers, little information is available about the patient symptom experience, symptom management, and supportive care needs, especially three months or more after therapy. This was a qualitative study. Participants were recruited from a comprehensive medical center if they met the following criteria: > 18 years of age, English-speaking, history of B-cell lymphoma, received tisa-cel or liso-cel between 3 months to one year, and currently in remission. Data collection utilized semi-structured telephone interviews that were audio-recorded and transcribed. Two independent coders used NVivo Software to code transcripts. Content analysis was used to analyze the interview data. Data analysis is ongoing. Ten patients who received tisa-cel (n=7) or liso-cel (n=3) for B-cell lymphoma participated in the study. The average time since infusion was 187.5 days, ranging from 113 to 261 days. Participant mean age was 64.5 years. Cytokine Release Syndrome (CRS) and Immune Effector Cell Associated Neurotoxicity Syndrome (ICANS) toxicity grades were gathered from medical chart review: CRS grade 0 (n=3), CRS grade 1 (n=5), CRS grade 2 (n=i), CRS grade 3 (n=i), and ICANS grade 0 (n=io). The most commonly described symptoms included fatigue, weakness, joint pain, and memory-issues. Most participants reported they were self-sufficient in their activities of daily living. However, some participants expressed physical limitations and social isolation, due to compromised immune systems and concerns related to COVID -19. Participants described the perceived burden for their caregivers. Supportive care needs included cooking meals and grocery shopping. Though our study focused on patients in remission to avoid confounding with ongoing disease or treatment, patients still reported symptoms and side effects. Notably, some participants experience symptoms (e.g., neuropathy) from prior chemotherapy treatments. Participants expressed being unsure of whether ongoing symptoms were related to prior treatments or from the CAR T-cell therapy. Oncology nurses should continue to assess symptoms among adult CAR T-cell patients in remission and offer supportive care as needed. Future research may determine what patients are more at risk of developing long-term symptoms, to describe symptom trajectory, and develop targeted interventions to reduce symptom burden and meet supportive care needs.

Outcomes of Tisagenlecleucel in Lymphoma Patients With Predominant Management in an Ambulatory Setting.

INTRODUCTION: Chimeric antigen receptor T-cell therapy (CAR T) is a revolutionary adoptive immunotherapy approach in lymphoma; however, substantial resources are necessary for administration and care of these patients. Our institution has administered tisagenlecleucel primarily in an outpatient setting, and here we report our clinical outcomes. PATIENTS AND METHODS: We conducted a single institution, retrospective study investigating outcomes of adult lymphoma patients treated with commercial tisagenlecleucel between 10/2017 and 12/2020. We analyzed patient characteristics and outcomes of efficacy and safety including overall response rate, progression-free survival, overall survival and cytokine-release syndrome, neurotoxicity, and hospitalizations. RESULTS: Seventy-two patients with relapsed or refractory non-Hodgkin lymphoma (NHL) who received commercial tisagenlecleucel were identified; 68 (94.4%) patients received outpatient tisagenlecleucel. The overall response rate was 43% with a complete response observed in 25 patients (34.7%). At a median follow-up of 9.1 months, the median progression-free survival was 3.3 months. Grade 3-4 cytokine release syndrome was not observed in the study group and two patients had grade 3-4 neurotoxicity. Twenty-six patients (36.1%) were admitted within 30 days after infusion with a median length of stay of 5 days. Fourteen patients (19.4%) were admitted within 72 hours of infusion. No patient died of CAR T cell-related toxicity. CONCLUSION: Our experience affirms treatment with tisagenlecleucel in the outpatient setting is safe and feasible with close supervision and adequate institutional experience. After infusion, adverse events were manageable and the majority of patients did not require hospitalization.

A regional multidisciplinary team approach from the general paediatric perspective, in a tertiary centre for suspected PIMS-TS

BackgroundAlder Hey Children’s Hospital (AHCH) in Northwest England provides regional specialist services and local general paediatric care. Paediatric multisystem inflammatory syndrome temporally associated with Covid-19 (PIMS-TS) is a new disease entity requiring paediatricians from District General Hospitals (DGHs) to seek advice from a number of specialists. During the first/second peak of the pandemic, patients with suspected PIMS-TS were transferred to AHCH under general paediatricians with subspecialist input.To optimise patient care, during the 3rd peak of the pandemic (January 2021) an efficient virtual multidisciplinary team (MDT) consisting of rheumatology, cardiology, infectious disease and general paediatrics, was created to facilitate discussion of potential PIMS-TS cases. The MDT aimed to coordinate management of patients requiring specialist input, reduce unnecessary transfers whilst ensuring appropriate case management and utilisation of resources.Daily (including weekends) virtual meetings were held to discuss all active referrals including the patient’s lead clinician, with the option of discussion on consecutive days until clinical improvement.ObjectivesTo analyse the cohort discussed at the MDT (January-March 2021), including demographics, outcomes, and need for transfer to AHCH.MethodsAn online referral form using Microsoft SharePoint was distributed to regional DGHs for completion prior to the MDT. Discussion was documented on a database and outcome uploaded to AHCH patient records. These records were reviewed for this study.Results35 patients were referred over the 6 week study period. 14 (44%) were female. 21 referrals came from DGHs (66%), the remainder were internal. Age range was 4 months to 17 years;9.3% <1year, 25% 2–5 years, 40.6% 6–11 years and 25% 12–17 years. At time of discussion, six had a positive covid-19 PCR test and 13 had a confirmed positive household/family contact. PIMS-TS was diagnosed in 7(20%) patients, three of whom were referred from DGHs. One required transfer to AHCH for inotropic support and one for echocardiogram. Two additional transfers to AHCH for surgical opinions were subsequently referred to the MDT. Of the remaining 25 patients (18 from DGHs), four were treated locally for Kawasaki’s disease. 19 of 21 (90.5%) DGH referrals to the MDT (majority without PIMS-TS) avoided unnecessary transfer to AHCH for assessment.ConclusionsThe daily virtual MDT allowed efficient discussion with exchange of expertise and a collaborative approach from several specialties for suspected PIMS-TS cases across the region. It also enabled continuity across multiple discussions about individual cases. It provided the opportunity to discuss differentials in a new disease entity, empower DGH clinicians to start early treatment of PIMS-TS and recruit where appropriate to the RECOVERY trial. Unnecessary transfers were avoided in 90.5% of external cases. General paediatricians are key valued team members as the spectrum of disease and possible differential is wide. This MDT approach promoted the role of the general paediatrician in caring for these patients. Early treatment with a lower threshold to react and escalate has improved patient care. The use of better IT infrastructure helped bridge the gap of care delivery by geography. Feedback from DGH participants in the MDT was positive.

Family cluster of three cases of monkeypox imported from Nigeria to the United Kingdom, May 2021.

Most reported cases of human monkeypox occur in Central and West Africa, where the causing virus is endemic. We describe the identification and public health response to an imported case of West African monkeypox from Nigeria to the United Kingdom (UK) in May 2021. Secondary transmission from the index case occurred within the family to another adult and a toddler. Concurrent COVID-19-related control measures upon arrival and at the hospital, facilitated detection and limited the number of potential contacts.

Presentation, Treatment Response and Short-Term Outcomes in Paediatric Multisystem Inflammatory Syndrome Temporally Associated with SARS-CoV-2 (PIMS-TS).

The novel Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) is the pathogen responsible for Coronavirus Disease 2019 (COVID-19). Whilst most children and young people develop mild symptoms, recent reports suggest a novel paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS). Case definition and classification are preliminary, treatment is empiric and disease-associated outcomes are unclear. Here, we report 29 patients with PIMS-TS who were diagnosed, admitted and treated in the English North West between March and June 2020. Consistent with patterns observed internationally, cases peaked approximately 4 weeks after the initial surge of COVID-19-like symptoms in the UK population. Clinical symptoms included fever (100%), skin rashes (72%), cardiovascular involvement (86%), conjunctivitis (62%) and respiratory involvement (21%). Some patients had clinical features partially resembling Kawasaki disease (KD), toxic shock syndrome and cytokine storm syndrome. Male gender (69%), black, Asian and other minority ethnicities (BAME, 59%) were over-represented. Immune modulating treatment was used in all, including intravenous immunoglobulin (IVIG), corticosteroids and cytokine blockers. Notably, 32% of patients treated with IVIG alone went into remission. The rest required additional treatment, usually corticosteroids, with the exception of two patients who were treated with TNF inhibition and IL-1 blockade, respectively. Another patient received IL-1 inhibition as primary therapy, with associated rapid and sustained remission. Randomized and prospective studies are needed to investigate efficacy and safety of treatment, especially as resources of IVIG may be depleted secondary to high demand during future waves of COVID-19.

Chimeric Antigen Receptor T Cell Therapy During the COVID-19 Pandemic.

The SARS-CoV-2 coronavirus (COVID-19) pandemic has significantly impacted the delivery of cellular therapeutics, including chimeric antigen receptor (CAR) T cells. This impact has extended beyond patient care to include logistics, administration, and distribution of increasingly limited health care resources. Based on the collective experience of the CAR T-cell Consortium investigators, we review and address several questions and concerns regarding cellular therapy administration in the setting of COVID-19 and make general recommendations to address these issues. Specifically, we address (1) necessary resources for safe administration of cell therapies; (2) determinants of cell therapy utilization; (3) selection among patients with B cell non-Hodgkin lymphomas and B cell acute lymphoblastic leukemia; (4) supportive measures during cell therapy administration; (5) use and prioritization of tocilizumab; and (6) collaborative care with referring physicians. These recommendations were carefully formulated with the understanding that resource allocation is of the utmost importance, and that the decision to proceed with CAR T cell therapy will require extensive discussion of potential risks and benefits. Although these recommendations are fluid, at this time it is our opinion that the COVID-19 pandemic should not serve as reason to defer CAR T cell therapy for patients truly in need of a potentially curative therapy.