Curriculum standards

Knowledge guides

LG21: Cellular and immune effector therapies

Clinical sciences

Advanced Trainees will describe the principles of the foundational sciences.

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Eligibility considerations

Advanced Trainees will assess the patient’s current condition and plan the next steps.

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Less common or more complex patient considerations

Advanced Trainees will understand the resources that should be used to help manage patients.

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Undertaking therapy

Advanced Trainees will monitor the progress of patients during the therapy.

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Post therapy

Advanced Trainees will know how to monitor and manage patients post-therapy.

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Important specific issues

Advanced Trainees will identify important specialty-specific issues and the impact of these on diagnosis and management, and integrate these into care.

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Cellular therapy and immune effector-specific immune-related adverse events
Determinants of efficacy and failure in:
- cellular therapy
- immune cell engaging agents
Manufacturing steps, including awareness of temporal impact of manufacturing processes
Post-treatment infection risk and immune reconstitution patterns
Principles of:
- generation of immune effector cell engager molecules
- immune effector cell transduction with genetic constructs
- treatment of cellular therapy and immune effector-specific immune-related adverse events
Reasons for failure of manufacture during stages of collection, manufacture, and receipt of cells for infusion
Sources of cells, and types suitable for manufacturing of cellular therapies

Appropriateness of required post-treatment care pathways and patient disposition
Choice of appropriate holding and bridging treatments
Disease indications and appropriate product selection
Impact of disease control on product selection and treatment pathways
Impact of pre-existing comorbidities on risks of toxicity and complications of therapy
Impact of prior therapy on product selection
Impact of product selection on choice of prophylactic and supportive therapies
Qualification criteria for chimeric antigen receptor (CAR) T-cell therapy relating to previous lines of treatment

Consideration of inclusion of patients in clinical research
Management of patients in regional and remote locations, and impact of patient disposition
Management of patients with comorbidities and patients of older age

Awareness and choice of appropriate preparative regimens, including lymphodepleting chemotherapy or use of monoclonal antibodies, relevant to local institutional protocols
Awareness of impact of level of disease control and impact on prophylactic and supportive care pathways
Choice of appropriate prophylactic and supportive care elements
Recognition of specific toxicity syndromes and appropriate interventions:
- cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS)
- immune effector cell-associated haemophagocytic lymphohistiocytosis-like syndrome (IEC-HS)

Appropriate disease restaging and re-assessment pathways
Awareness of biology relevant to post-treatment relapse therapy choices
Awareness of longer-term secondary malignancy risk and screening
Awareness of short- and long-term toxicities, non-specific and on target and off tumour, including:
- immune effector cell-associated haematotoxicity (ICAHT)
- long-term specific immune cell aplasia
Knowledge of institutional care pathways relevant to therapy received, including routine monitoring
Long-term complications in immunotherapy and follow-up
Long-term monitoring concerns, including measurable residual disease and prolonged cytopenias

Clinical trials availability, and processes for cross-referral
Emerging indications and new immune cell engaging therapies
Emerging indications and new products in CAR T-cell therapy