Real-World Liso-cel Safety: Key Nursing Insights for R/R MCL Management

As chimeric antigen receptor (CAR) T-cell therapy moves from highly controlled clinical trials into broader clinical practice, oncology nurses are at the forefront of managing increasingly complex patient populations.

New real-world evidence presented at the European Hematology Association (EHA) 2026 Annual Congress provided a detailed roadmap for nursing teams caring for patients with relapsed or refractory (R/R) mantle cell lymphoma (MCL) receiving lisocabtagene maraleucel (liso-cel, Breyanzi).The analysis, drawing from the Center for International Blood and Marrow Transplant Research (CIBMTR) registry, highlights that while liso-cel is highly effective, its real-world application involves older patients with significant comorbidities, necessitating specialized nursing assessment and proactive symptom management.

Assessing the real-world patient profile

A primary takeaway for oncology nurses is the demographic shift seen in real-world practice compared to pivotal trials. The CIBMTR cohort of 121 patients had a median age of 71 years. Furthermore, 66% of these patients presented with at least one clinically significant comorbidity at the time of CAR T-cell infusion.

Nurses should be prepared to manage patients with baseline cardiovascular or cerebrovascular disease (30%). These baseline factors require diligent nursing assessment, as comorbidities can complicate the presentation and management of therapy-related toxicities.

Navigating toxicity: Onset and duration

For the nursing team, the timing of adverse events is critical for monitoring and bed-resource planning. The study confirmed that liso-cel maintains a relatively predictable and manageable safety profile.

• Cytokine Release Syndrome (CRS): CRS occurred in 65% of patients. Nurses should focus their highest level of surveillance on the first week; the median time to CRS onset was 4 days, with a median duration of 3 days.
• Immune Effector Cell-Associated Neurotoxicity Syndrome (ICANS): ICANS occurred in 36% of patients. The onset of neurotoxicity typically occurs later than CRS, with a median onset of 7 days and a median duration of 4.5 days.

Nurses play a pivotal role in the early detection of ICANS through frequent neurological assessments (such as ICE scores).

The shift to outpatient care

One of the most significant trends for oncology nursing is the delivery of CAR T-cell therapy in the outpatient setting. In this study, 39% of patients received their liso-cel infusion as outpatients. This transition shifts the burden of monitoring to outpatient nursing teams and caregivers.

Nurses are essential in educating patients and caregivers on the "red flag" symptoms that necessitate a return to the hospital. According to the data, 28% of patients who began as outpatients required subsequent hospitalization, with a median time to admission of 5.5 days following infusion. This reinforces the need for close nursing contact and rapid-triage protocols during the first 10 days post-infusion.

Long-term vigilance: Cytopenias and infection

The nursing role extends well beyond the immediate post-infusion period. The CIBMTR data revealed that 17% of patients experienced prolonged cytopenias at Day 30. Additionally, 24% of patients developed clinically significant infections.

Oncology nurses should ensure patients are discharged with clear instructions regarding infection prophylaxis, temperature monitoring, and the necessity of ongoing blood counts. The most common infections reported were bacterial (17%), followed by viral (9%) and fungal (3%).

Efficacy as a clinical driver

While safety and management are the nursing priorities, the efficacy results provide the clinical context for why this intensive therapy is utilized. The real-world overall response rate (ORR) was 89%, with a complete response (CR) rate of 79%. Even in patients who had failed prior Bruton tyrosine kinase (BTK) inhibitors — a group that traditionally has very poor outcomes — the CR rate remained high at 75%.

Nursing implications for clinical practice

The CIBMTR data confirms that liso-cel is a viable option for a broad, real-world MCL population. For oncology nurses, these findings emphasize:

• Strict Adherence to Monitoring Timelines: Knowing that CRS typically starts on Day 4 and ICANS on Day 7 allows for targeted vigilance.
• Comorbidity Awareness: Older patients with pre-existing conditions require more frequent vital sign and organ-function assessments.
• Outpatient Education: Nurses must empower caregivers to recognize subtle changes that may indicate the need for hospitalization.

As CAR T-cell therapy becomes more integrated into the standard of care for MCL, the expertise of the oncology nurse remains the most critical component in ensuring these high response rates are achieved safely.

Reference

1. Huang JJ, Brooks T, Romaniuk J, et al. Outcomes of lisocabtagene maraleucel in patients with relapsed or refractory mantle cell lymphoma: first real-world data from the CIBMTR. Poster presented at: European Hematology Association (EHA) 2026 Congress; June 11-14, 2026; Stockholm, Sweden. Abstract PF935.