CAR-T(CAR-T)细胞疗法在非肿瘤性疾病中的应用
Chimeric antigen receptor T (CAR-T) cell therapy in non-oncological diseases.
CAR-T(CAR-T)细胞在血液系统恶性肿瘤中的应用推动了这种免疫治疗形式的显著进展。
CELL INTELLIGENCE · 肿瘤细胞治疗研究
肿瘤细胞治疗研究
英文原题:Protocol for a mixed-methods study to develop and feasibility test a digital system for the capture of patient-reported outcomes (PROs) in patients receiving chimeric antigen receptor T-cell (CAR-T) therapies (the PRO-CAR-T study).
Protocol for a mixed-methods study to develop and feasibility test a digital system for the capture of patient-reported outcomes (PROs) in patients receiving chimeric antigen receptor T-cell (CAR-T) therapies (the PRO-CAR-T study).
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引言:嵌合抗原受体(CAR)T细胞疗法是治疗血液系统恶性肿瘤的新型潜在治愈性疗法。CAR-T 治疗可能导致严重毒性,因此患者在急性期和后急性期均需监测。电子化患者报告结局(ePRO)是患者通过在线问卷自我报告健康状况,可补充临床医生观察,并有望改善患者结局。
本研究拟开发一种新的CAR-T 患者常规诊疗用ePRO系统,并评估其可行性。方法与分析:本研究采用多阶段混合方法,涉及多个利益相关方群体,包括患者、家庭成员、照护者、临床医生、学者/研究人员和政策制定者。干预开发阶段包括:通过Delphi研究选定数字系统所用的患者报告结局(PRO)测量工具;开展共同设计研讨会和共识会议,以确定患者报告严重症状或副作用时向临床团队发出通知的阈值。随后通过可用性测试评估用户与数字系统的交互方式;最后,在常规护理基础上对30例成年CAR-T 患者(年龄≥18岁)使用该系统,评估可行性。参与可行性研究者将在指定时间点通过ePRO系统提交症状、治疗耐受性和生活质量自我报告。CAR-T 临床团队收到由患者提交信息触发的系统通知后,将依照标准临床实践采取行动。在CAR-T 细胞输注后的预定时间点收集可行性指标。另开展一项定性子研究,探讨患者和临床团队成员对ePRO系统的接受度。伦理与传播:健康与社会关怀研究伦理委员会B(HSC REC B)于2023年9月28日批准本研究(编号:23/NI/0104)。研究结果将投稿至高质量同行评审期刊。研究团队将与血液和移植研究部患者及公众参与小组共同制定结果摘要,并向所有相关群体传播。试验注册号:ISCTRN11232653。
INTRODUCTION: Chimeric antigen receptor (CAR) T-cell therapies are novel, potentially curative therapies for haematological malignancies. CAR T-cell therapies are associated with severe toxicities, meaning patients require monitoring during acute and postacute treatment phases. Electronic patient-reported outcomes (ePROs), self-reports of health status provided via online questionnaires, can complement clinician observation with potential to improve patient outcomes.
This study will develop and evaluate feasibility of a new ePRO system for CAR-T patients in routine care. METHODS AND ANALYSIS: Multiphase, mixed-methods study involving multiple stakeholder groups (patients, family members, carers, clinicians, academics/researchers and policy-makers). The intervention development phase comprises a Delphi study to select PRO measures for the digital system, a codesign workshop and consensus meetings to establish thresholds for notifications to the clinical team if a patient reports severe symptoms or side effects. Usability testing will evaluate how users interact with the digital system and, lastly, we will evaluate ePRO system feasibility with 30 CAR-T patients (adults aged 18+ years) when used in addition to usual care. Feasibility study participants will use the ePRO system to submit self-reports of symptoms, treatment tolerability and quality of life at specific time points.
The CAR-T clinical team will respond to system notifications triggered by patients' submitted responses with actions in line with standard clinical practice. Feasibility measures will be collected at prespecified time points following CAR T-cell infusion. A qualitative substudy involving patients and clinical team members will explore acceptability of the ePRO system.
ETHICS AND DISSEMINATION: Favourable ethical opinion was granted by the Health and Social Care Research Ethics Committee B(HSC REC B) (ref: 23/NI/0104) on 28 September 2023. Findings will be submitted for publication in high-quality, peer-reviewed journals. Summaries of results, codeveloped with the Blood and Transplant Research Unit Patient and Public Involvement and Engagement group, will be disseminated to all interested groups. TRIAL REGISTRATION NUMBER: ISCTRN11232653.
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