Dados do Resumo

Título

Physiotherapeutic Rehabilitation in a Child Undergoing CAR-T Cell Therapy: A Case Report

Introdução

Considered the fifth pillar of antineoplastic treatment, immunotherapy has brought significant advances to science, particularly CAR-T cell therapy (Chimeric Antigen Receptor T-Cell), which has shown promising effects in children with Acute Lymphoblastic Leukemia. Despite its efficacy, the treatment is associated with complications such as cytokine release syndrome, neurotoxicity, and the presence of functional and neurological deficits. In this context, physical therapy plays a crucial role in rehabilitation, helping to minimize these deficits, improve mobility, muscle strength, and quality of life.

Objetivo

To report the case of the first child undergoing CAR-T cell therapy at the Hospital Israelita Albert Einstein and the physiotherapeutic approach during the course of hospitalization, performing functional rehabilitation in the pre- and post-infusion phases of T cells, considering the peculiarities arising from each phase of the treatment.

Métodos

The methodology used was the case report of a child undergoing CAR-T cell therapy at the Hospital Israelita Albert Einstein, utilizing information described in the evaluation records and consultations conducted by the physiotherapy team.

Resultados

A 9-year-old male child with a diagnosis of B-cell Acute Lymphoblastic Leukemia (B-ALL) with a history of early relapse in other treatment modalities, meeting the eligibility criteria for CAR-T cell therapy. In the pre-infusion physiotherapeutic evaluation, cardiorespiratory deconditioning, reduced muscle strength, and limited range of motion in the upper limbs were identified. Given this condition, the physiotherapeutic approach was based on the prescription of aerobic activities such as cycloergometer, muscle strengthening exercises, and mobility, introduced in a playful manner.
After the infusion of CAR-T cells and the development of cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS), there was a worsening of factors related to muscle strength and balance deficits. Thus, after clinical stability, physiotherapy activities were resumed, focusing on muscle strengthening, lung expansibility, balance, and aerobic conditioning, preparing the patient for the return to previous activities and enhancing the effectiveness of the therapy.

Conclusões

The multidisciplinary follow-up during the different phases of CAR-T cell therapy allows for the early identification and intervention of factors that may influence clinical outcomes during treatment. Physiotherapy plays a fundamental role in minimizing the functional deficits that arise during treatment and preventing their progression. The ultimate goal is to ensure that the patient returns to previous activities with preserved functionality and the lowest possible degree of sequelae resulting from the therapy.

Palavras Chave

CAR-T cell therapy; Physiotherapeutic Rehabilitation; Acute Lymphoblastic Leukemia