Introduction
Cellular immunity using T-cells and their chimeric antigen receptors to redirect their cytotoxic specificity against tumor cells (CAR T-cell therapy) is a new and emerging treatment for a number of cancers.  Cytokine Release Syndrome (CRS) and CAR T-cell related Encephalopathy Syndrome (CRES) are common toxicities and can cause significant medical and functional morbidity.
 
Although not previously documented in CAR T-cell treated cancer patients, acute inpatient cancer rehabilitation has been shown to be effective in patients with neutropenic and thrombocytopenic precautions, requiring frequent transfusion support, and with significant neurologic deficits.


Objective

To describe the inpatient course including acute inpatient rehabilitation of a lymphoma patient status post CAR T-cell therapy with CRS and CRES toxicities.


Methods

Case report from retrospective chart review.


Results

From initial hospitalization status post CAR T infusion until discharge from the inpatient rehabilitation unit (IRU) the patient’s CRS score improved from 3 (ICU) to 0 (IRU), CRES score improved from 4 (ICU) to 0 (IRU) and FIM mobility score improved from 1 (ICU) to 4 (IRU.)

The patient required platelet transfusions 4 of 7 days and PRBC transfusion 3 of 7 days on the rehabilitation unit.

He was safely discharged home with family assistance.


Conclusion

A CAR T-cell therapy patient after CRS and CRES toxicities was managed with comprehensive inpatient rehabilitation, medical and symptom management and discharged to the home setting.

15 - INPATIENT CANCER REHABILITATION IN A CAR T-CELL THERAPY LYMPHOMA PATIENT WITH CRS AND CRES TOXICITY