Clayden Robert, Gunka Barbara, Salter Brittany, Dong Audrey Y H, Lepic Kylie, Davies Gwynivere, Balitsky Amaris
Department of Oncology, St Catharines General Hospital, St Catharines, Canada.
Department of Medicine, McMaster University, Hamilton, Canada.
Hematology. 2025 Dec;30(1):2519865. doi: 10.1080/16078454.2025.2519865. Epub 2025 Jun 23.
CD19-targeted chimeric antigen receptor T-cell (CAR-T) therapy has transformed treatment for relapsed/refractory large B-cell lymphoma, offering promising remission rates. However, it carries significant infectious risks, necessitating revaccination for infection prevention.
This single-center quality improvement study aimed to (1) assess revaccination uptake and barriers in CAR-T recipients through interviews and focus groups, and (2) use qualitative insights to develop an educational handout to improve revaccination adherence. The study was conducted at Juravinski Hospital and Cancer Centre, Hamilton, Ontario, and enrolled 22 patients who received CAR-T between January 2020 and June 2023. Participants completed a survey evaluating their revaccination experience, which informed the development of a patient-facing educational handout. A focus group of survey participants then reviewed the handout and offered feedback on its clarity and usefulness.
Only 50% of participants proceeded with revaccination. Key barriers included limited awareness among primary care providers (PCPs), poor communication between hematologists and PCPs, and logistical difficulties. The focus group highlighted gaps in understanding post-CAR-T immunization needs and emphasized the importance of patient and physician education. Participants supported the creation of a concise handout outlining the revaccination schedule and clarified the PCP's role in coordination.
This study underscores the need for improved communication across care providers and accessible patient education to support post-CAR-T revaccination. Future efforts should focus on implementing and evaluating targeted educational tools to enhance vaccine uptake in this high-risk population..
靶向CD19的嵌合抗原受体T细胞（CAR-T）疗法改变了复发/难治性大B细胞淋巴瘤的治疗方式，缓解率令人期待。然而，该疗法存在重大感染风险，因此需要重新接种疫苗以预防感染。
这项单中心质量改进研究旨在：（1）通过访谈和焦点小组评估CAR-T治疗接受者重新接种疫苗的情况及障碍；（2）利用定性研究结果制定一份教育手册，以提高重新接种疫苗的依从性。该研究在安大略省汉密尔顿市的朱拉温斯基医院和癌症中心进行，纳入了2020年1月至2023年6月期间接受CAR-T治疗的22名患者。参与者完成了一项评估其重新接种疫苗经历的调查，该调查为面向患者的教育手册的制定提供了依据。随后，一个由参与调查的人员组成的焦点小组对该手册进行了审查，并就其清晰度和实用性提供了反馈。
只有50%的参与者进行了重新接种。主要障碍包括初级保健提供者（PCP）认识不足、血液科医生与PCP之间沟通不畅以及后勤困难。焦点小组强调了在理解CAR-T治疗后免疫需求方面存在的差距，并强调了患者和医生教育的重要性。参与者支持创建一份简明手册，概述重新接种疫苗的时间表，并明确PCP在协调中的作用。
本研究强调了改善医疗服务提供者之间的沟通以及提供易于获取的患者教育以支持CAR-T治疗后重新接种疫苗的必要性。未来的工作应侧重于实施和评估有针对性的教育工具，以提高这一高风险人群的疫苗接种率。
