A real-world analysis of adverse events and operational impacts of using T-cell engager therapy in an oncology setting.

Background: T-cell engager (TCE) therapies are an emerging immunotherapy option for hematologic malignancies and small-cell lung cancer. While effective, they are associated with cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS), particularly during ramp-up dosing. Evidence to guide nursing assessment, monitoring, and operational planning in real-world settings remains limited. Purpose: To describe the frequency, severity, timing, and management of CRS and ICANS among patients receiving TCE therapy at a community hospital oncology program, and to explore operational impacts, such as length of stay and geographic considerations. Methods: A retrospective chart review of 30 patients who received TCE therapy at the Osler Oncology Program at Brampton Civic Hospital between August 2023 and May 2025 was conducted. Demographic, treatment, adverse event, and operational data were abstracted from electronic medical records using standardized forms. Cytokine release syndrome and ICANS were graded using American Society for Transplantation and Cellular Therapy (ASTCT) criteria. Descriptive statistics were used to summarize outcomes. Results: Cytokine release syndrome occurred in 77% (23/30) of patients, predominantly Grade 1 (70% of CRS cases), with most events occurring within 24 hours of ramp-up dosing and primarily following Dose 1. Immune effector cell-associated neurotoxicity syndrome occurred in 27% (8/30) of patients, including one Grade 4 event. Seventy-five percent of ICANS cases occurred in patients who also experienced CRS. Early use of tocilizumab for Grade 1 CRS appeared to reduce progression to higher grades. Mean total length of stay across ramp-up dosing was 11.4 days, decreasing from 7.2 days for the initial visit to 1.6 days for Dose 3. Conclusions: T-cell engager therapy in a community oncology setting is feasible but requires structured nursing assessment protocols, intensive early monitoring, and evolving management strategies. Findings support exploration of risk-stratified outpatient models for selected patients.