嵌合抗原受體T細胞（CAR-T）治療的發展與護理

Development of Chimeric Antigen Receptor T Cells (CAR-T) Therapy and Its Nursing Care

免疫療法是癌症治療的趨勢，其中2017年於美國上市的CAR-T（chimeric antigen receptor T cells）治療是針對難治與復發型B細胞急性淋巴型白血病及非霍奇金式淋巴瘤的新興免疫治療方式。CAR-T治療利用病息本身T細胞作為載體，嵌合癌細胞抗原受體，以增強T細胞辨識癌細胞之能力，但也因其免疫功能增強，易造成包括細胞激素釋放症候群（cytokine release syndrome）與神經毒性（neurological toxicity）等主要副作用，病息在輸注CAR-T後會出現發燒、低血壓、低血氧、精神狀態改變與癲癇等現象；護理人員對於副作用徵象的及早辨別與護理將有助於降低副作用發生。本文概述CAR-T的治療、副作用及探討護理人員的角色，以期能強化護理人員在照護CAR-T治療之症狀識別與照護，提升護理照護品質與病人安全。

Cancer immunotherapy enhancing immune responses to fight cancer cells. As one kind of immunitherapies, chimeric antigen receptor T cells (CAR-T) therapy was launched in America at the year 2017 and had been indicated to treat refractory and relapse B-cell acute lymphoblastic leukemia and non-Hodgkin's lymphoma. The CAR-T therapy involves modifing T cells to recognize cancer cells more effectively. Scientists harvest T cells (derived from T cells in a patient's own blood), genetically alter them, then infuse the resulting CAR-T cells into patients to attack their own cancer cells. With enhacing immune responses, cytokine release syndrome and neurological toxicity commonly occurred as adverse events. Patients may presented with fever, hypotension, hypoxemia, confusional state change with seizure episodes. In this article, we briefly introduce the CAR-T therapy and its adverse events with an eye toward promting the role of nurses in caring for these hightly voulnerable patients before, during, and after CAR-T therapy.