[Basic Principle and Pharmacological Mechanism of the Chimeric Antigen Receptor (CAR)-T Cell]

Chimeric antigen receptor T-cell (CAR-T) therapy is an advanced immunotherapy designed for the effective treatment of patients with refractory or relapsed hematologic malignancies. In recent years, CAR-T therapy has demonstrated remarkable therapeutic efficacy in applications on diseases such as acute lymphoblastic leukemia and diffuse large B-cell lymphoma. The treatment approach involves collecting a patient's own T cells and genetically engineering them to express a CAR structure, enabling specific recognition of tumor-associated antigens. Reinfused into the patient, these modified T cells undergo robust expansion, secrete cytokines, and directly induce apoptosis in tumor cells. CAR-T cells typically comprise three domains, namely antigen-recognition, signaling, and co-stimulatory, each of which influences the activity and toxicity profile of these cells. The CAR-T cell therapy process includes patient evaluation, leukapheresis, gene transduction and cell expansion, lymphodepleting chemotherapy, and CAR-T infusion, all of which require multidisciplinary collaboration. The common adverse effects of CAR-T therapy, including cytokine release syndrome and neurotoxicity, must be closely monitored for and graded by nursing staff for early intervention. In addition, delayed toxicities such as pancytopenia or hypogammaglobulinemia may occur, necessitating long-term follow-up and supportive care. Nurses play a pivotal role throughout the CAR-T treatment process in terms of providing clinical monitoring, patient education, and psychological support; ensuring treatment safety; and optimizing overall patient care quality.