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