Background: The use of cellular therapy and cancer immunotherapy (including chimeric antigen receptor (CAR) T-Cell therapy and bispecific antibodies) in malignant hematology and solid tumor oncology has greatly increased over the last few years. These novel treatments have a unique set of toxicities such as Cytokine Release Syndrome (CRS) and Immune Effector Cell-Associated Neurotoxicity Syndrome (ICANS) that require specialized care. Hospitalists have varying levels of experience in managing these toxicities yet are often involved in multidisciplinary care of these patients when they are admitted to the hospital. At the Cleveland Clinic, the Cellular and Immunotherapy Service (CITS) was established in July 2024 to help streamline and develop expertise in the care of these patients, with hospitalists responsible for direct in-house patient care during overnight hours.
Purpose: We aimed to evaluate hospitalists’ baseline experience and knowledge regarding the management of CRS and ICANS, and to identify opportunities to enhance familiarity and multidisciplinary communication around toxicity management.
Description: With the establishment of CITS, we surveyed hospitalists who would be providing care for these patients overnight. 100% of hospitalists surveyed (17/17) had prior experience caring for Bone Marrow Transplant patients. 88.9% (16/17) agreed they had the tools and resources needed to effectively care for CITS patients yet only 58.9% (10/17) felt comfortable managing CRS and 52.9% (9/17) felt comfortable managing ICANS. 5.9% (1/17) felt that the management algorithm for CRS was unclear and 17.6% (3/17) felt that the management algorithm for ICANS was unclear. Survey respondents suggested that patient specific CRS/ICANS management information could be communicated in a variety of formats, including on the daily progress note, a hand-off tool, or in a separate CRS/ICANS management note. In collaboration with the Taussig Cancer Institute at the Cleveland Clinic, we developed an immersive orientation program in which hospitalists caring for CITS patients would receive didactics on CRS/ICANS management followed by immersive rounding with the CITS team over a 5-day period. At the same time, an institution specific CRS/ICANS management algorithm was also established in March 2025. As of October 2025, 10 hospitalists had fully completed the orientation program with another 7 hospitalists in the process of completing the program. Following the intervention, a survey was conducted with 77.8% (7/9) of the respondents stating they felt comfortable managing CRS (compared to 58.9% pre-intervention) and 77.8% (7/9) stating they felt comfortable managing ICANS (compared to 52.9% pre-intervention), suggesting that educational interventions and collaborative rounding can enhance hospitalists’ comfort level in managing the toxicities associated with cellular and immunotherapy.
Conclusions: Targeted educational initiatives and collaborative patient management can effectively enhance hospitalists’ confidence in treating complex toxicities related to cellular and immunotherapy. This project highlights the importance of tailored training, clear management algorithms, and multi-disciplinary collaboration in the management of patients receiving cellular therapy and immunotherapy.