Creating a Cellular Therapy Elective for Senior Hematology/Oncology Fellows- a Needs Assessment
Authors: Melody Megan , Chandra Sunandana , Moreira Jonathan 
Published: December 2024

Background: Chimeric antigen receptor (CAR) T-cell therapy and bispecific antibody therapies (BsAbs) are novel and complex treatment modalities associated with unique side effect profiles, namely cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS). Historically, these cellular therapies and associated toxicities have been managed by experts in the field. With the expanded application of CAR T/BsAbs (cellular therapy) into solid tumor malignancies, it is essential that all graduating hematology/oncology fellows develop confidence and competence managing patients treated with these cellular therapies and their associated toxicities. There are a limited number of non-ACGME accredited, one-year fellowship opportunities in the field of Hematopoietic Stem Cell Transplantation (HSCT) and cellular therapy. Cellular therapy exposure for hematology/oncology fellows at Northwestern University is limited to a 1-month inpatient rotation during the 1st year of fellowship.

Objectives: 1)To evaluate fellows' confidence in the management of cellular therapies and associated toxicities after completion of required curriculum. 2) To assess interest in participating in an additional month-long cellular therapy elective that can be taken during the final year of fellowship.

Methods: We conducted a needs assessment in line with steps 1-2 of Kern's Model of Curriculum Development. Hematology/oncology fellows at Northwestern University were administered a 14-question survey at the end of the 2024 academic year. Questions were formatted on a 5-poin Likert scale from “Not confident at all” to “Completely confident”. At the time of survey administration, all fellows had completed at least one-month long rotation on the Stem-Cell Transplant/Cellular Therapy inpatient service as part of the Northwestern University Hematology/Oncology Fellowship core curriculum.

Results: Seventeen fellows completed the survey (100% response rate). Ten fellows (58.8%) expressed an interest in pursuing a career that would include the use of cellular therapy into their clinical practice. Most fellows felt comfortable recognizing common toxicities associated with cellular therapy, with 52.9% feeling “confident” and 41.2% “extremely confident” recognizing symptoms of CRS. 52.9% felt “confident” and 23.5% “extremely confident” recognizing symptoms of ICANS. Additionally, the majority of fellows felt either “confident” (52.9%) or “extremely confident” (23.5%) in administering Tocilizumab for the management of CRS. 70.6% felt either “confident” or 5.9% “extremely confident” in administering steroids for the management of ICANS. However, 76.5% of fellows did not feel confident administering Anakinra for the management of ICANS. Additionally, 14/17 (82.3%) fellows did not feel confident pursuing a job which would require them to “independently manage some patients treated with CAR T-cell therapy or BsAbs.” Only 1 fellow planned to participate in the proposed Cellular Therapy Elective during their final year of fellowship. with 29.4% selecting they were “not sure” and 64.7% did not plan on participating in the elective. The most commonly selected reasons for not participating in the elective were: “no interest” (56.3%), “time commitment” (43.8%), “long hours” (31.3%), and “will gain enough experience through moonlighting opportunities” (31.3%).

Conclusion/Future Directions: More than half of survey participants expressed interest in a career that will require management of patients treated with cellular therapy and associated toxicities; however, nearly 25% of fellows did not feel equipped to administer front-line treatment for CRS or ICANS. Additionally, the majority did not feel confident pursuing a professional position that would require independent management of such patients. Despite this, most fellows do not plan to pursue an additional cellular therapy elective during their senior year of fellowship. The most common barriers to participation were lack of interest and time. Given time constraints during fellowship, further integration of cellular therapy education into core fellowship curriculum may be warranted given the broadening applicability of these therapies to patients outside of malignant hematology.