Transformative Care: A Nurse Guide to Novel Therapies in Blood Cancers

Beth Faiman, PhD, MSN, APN-BC, BMTCN, AOCN, FAAN, FAPO

The landscape of hematologic oncology has been fundamentally reshaped by novel immunotherapies, summarized Beth Faiman, PhD, MSN, APN-BC, BMTCN, AOCN, FAAN, FAPO, in a presentation during the 9^th Annual School of Nursing Oncology, an event hosted by Physicians’ Education Resource®, LLC.

For oncology nurses, their role extends beyond administration to include proactive, supportive care and a deep understanding of these complex treatments. T-cell redirecting therapies, which include CAR T-cell therapy and bispecific antibodies, are at the forefront of this revolution.

In her presentation, Faiman spoke on the therapeutic advances with CAR T-cell therapy and bispecific antibodies, current indications and sequencing decisions, and proper supportive care measures to ensure optimal patient care.

While highly effective, both types of therapy come with a unique set of toxicity challenges, most notably with cytokine release syndrome (CRS) and immune-effector cell-associated neurotoxicity syndrome (ICANS). These effects are observed across patients with non-Hodgkin lymphomas and multiple myeloma.

“Why are T-cell redirecting therapies in hematologic malignancies so important? T cells’ responsibility is to fight, so we need to program them to be better fighters sometimes,” said Faiman.

“What we’re doing is taking the marker target on the cell—for example, CD20—and then CD3, like a helping hand, will bring it together and cause cell death when you’re directing these T cells. That causes a cytokine storm and a whole host of problems. […] That cytokine release syndrome and the neurotoxicity syndrome are constants, regardless of the disease state.”

CAR T-Cell Therapy: A Personalized Approach

The FDA-approved CAR T-cell therapies currently available, along with their indications, include:

• Tisagenlecleucel (Kymriah; tisa-cel):
  • pediatric and young adult patients (up to 25 years of age) with twice relapsed or refractory B-cell precursor acute lymphoblastic leukemia (ALL);
  • adult patients with relapsed or refractory large B-cell lymphoma (LBCL), including diffuse large B-cell lymphoma (DLBCL), high-grade B-cell lymphoma, and DLBCL arising from follicular lymphoma (FL), after 2 or more lines of systemic therapy;
  • adult patients with relapsed or refractory FL after 2 or more lines of systemic therapy.
• Axicabtagene ciloleucel (Yescarta; axi-cel):
  • adult patients with relapsed or refractory LBCL, including DLBCL, primary mediastinal large B-cell lymphoma, high-grade B-cell lymphoma, and DLBCL arising from FL, after 1 or more lines of systemic therapy;
  • adult patients with relapsed or refractory LBCL after 2 or more lines of systemic therapy.
• Brexucabtagene autoleucel (Tecartus; brexu-cel):
  • adult patients with relapsed or refractory mantle cell lymphoma (MCL);
  • adult patients with relapsed or refractory B-cell precursor ALL.
• Lisocabtagene maraleucel (Breyanzi; liso-cel):
  • adult patients with relapsed or refractory LBCL, including DLBCL, primary mediastinal large B-cell lymphoma, high-grade B-cell lymphoma, and FL grade 3B, after 1 or more lines of systemic therapy;
  • adult patients with relapsed or refractory chronic lymphocytic leukemia (CLL) or small lymphocytic lymphoma (SLL) who have received at least 2 prior lines of therapy, including a BTK inhibitor and a BCL-2 inhibitor;
  • adult patients with relapsed or refractory FL who have received at least 2 prior lines of systemic therapy;
  • adult patients with relapsed or refractory MCL who have received at least 2 prior lines of systemic therapy, including a BTK inhibitor.
• Idecabtagene vicleucel (Abecma; ide-cel):
  • adult patients with relapsed or refractory multiple myeloma after 2 or more prior lines of therapy, including an immunomodulatory agent, a proteasome inhibitor, and an anti-CD38 monoclonal antibody.
• Ciltacabtagene autoleucel (Carvykti; cilta-cel):
  • adult patients with relapsed or lenalidomide-refractory multiple myeloma after 1 or more prior lines of therapy, including a proteasome inhibitor and an immunomodulatory agent.
• Obecabtagene autoleucel (Aucatzyl; obe-cel):
  • adult patients with relapsed or refractory B-cell precursor ALL.

Faiman recommends referring to timing of relapse, response to prior therapy, aggressiveness of relapse, and performance status when selecting next therapies.

“One of the questions that I always get is, ‘How do you know which one to give to your patients?’”, Faiman said. “It’s based on the efficacy, safety and, primarily, the indication. If [a patient has] only had 1 prior line of therapy, you wouldn’t be able to give drug A; you would have to wait until they met the FDA indication.”

Timing also plays a significant role in whether a patient is eligible or fit enough to receive CAR T-cell therapy.

“If you have somebody with multiple myeloma who is blowing through therapies, has hard-to-control disease because the M spike is going high, and has a lot of burden of disease, they can’t wait to have cells manufactured for CAR T—would the patient be able to live long enough to get the cells back?”

Other considering factors focus on patients’ immediate prior line of therapy, whether they received a prior BCMA bispecific, and their willingness to undergo a CAR T-cell therapy procedure, which requires hospitalization and referrals to a CAR T-cell therapy center if one is not at the institution the patient is currently undergoing treatment at. Further areas to consider are whether a patient has any active infections and/or other non–disease-related comorbid conditions.

Bispecific Antibodies: An “Off-the-Shelf” Alternative

Bispecific antibodies are engineered, off-the-shelf options, Faiman explained.

“It’s not a cellular therapy. We can just write a prescription and go through the ramp-up and the step-up dosing, etc. of these drugs, and you don’t have to manufacture them. That’s a very attractive thing for patients.”

These are the FDA-approved bispecific antibodies for patients with hematologic cancers:

• Blinatumomab (Blincyto):
  • adult and pediatric patients with relapsed or refractory B-cell precursor ALL;
  • adult and pediatric patients with CD19-positive Philadelphia chromosome-negative B-cell precursor ALL that is in the consolidation phase of multiphase chemotherapy;
  • adult and pediatric patients with CD19-positive B-cell precursor ALL that is in first or second remission but still has minimal residual disease.
• Teclistamab (Tecvayli):
  • adult patients with relapsed or refractory multiple myeloma who have received at least 4 prior lines of therapy, including a proteasome inhibitor, an immunomodulatory agent, and an anti-CD38 monoclonal antibody.
• Mosunetuzumab (Lunsumio):
  • adult patients with relapsed or refractory FL after 2 or more lines of systemic therapy.
• Epcoritamab (Epkinly):
  • adult patients with relapsed or refractory DLBCL, not otherwise specified, including DLBCL arising from FL, after 2 or more lines of systemic therapy;
  • adult patients with relapsed or refractory FL after at least 2 lines of systemic therapy
• Glofitamab (Columvi):
  • adult patients with relapsed or refractory DLBCL, not otherwise specified, or LBCL arising from FL, after 2 or more lines of systemic therapy.
• Talquetamab (Talvey):
  • adult patients with relapsed or refractory multiple myeloma who have received at least 4 prior lines of therapy, including a proteasome inhibitor, an immunomodulatory agent, and an anti-CD38 monoclonal antibody.
• Elranatamab (Elrexfio):
  • adult patients with relapsed or refractory multiple myeloma who have received at least 4 prior lines of therapy, including a proteasome inhibitor, an immunomodulatory agent, and an anti-CD38 monoclonal antibody.
• Linvoseltamab-gcpt (Lynozyfic):
  • adults patients with relapsed/refractory multiple myeloma who have received at least 4 prior lines of therapy, including a proteasome inhibitor, an immunomodulatory agent, and an anti-CD38 monoclonal antibody.

Deciding on which bispecific to treat a patient with has a similar roadmap to the CAR T-cell therapy decision-making process, including evaluating current label indications as well as timing of relapse, response to prior therapy, aggressiveness of relapse, and performance status, Faiman said.

“It’s really critical,” said Faiman, who canvased all the characteristics of a patient’s disease and monitoring for each treatment’s related toxicities. “If there’s anything that you take away from this talk, if you’re in a community and not a large academic center, everybody is a candidate for CAR T at some time or another."

Editor’s Note: This is part 1 of a multi-part series of Beth Faiman’s presentation at the 9^th Annual School of Nursing Oncology.

Reference

Faiman B. Updates in novel therapies across hematologic malignancies. Presented at: 9^th Annual School of Nursing Oncology; August 9, 2025; Nashville, TN.