Application in evidence-based predictive nursing on patients with relapsed/refractory B-cell lymphoma receiving chimeric antigen receptor T-cell immunotherapy

doi:10.16138/j.1673-6087.2025.03.10

Abstract

Abstract:

Objective To explore the clinical application and effectiveness of evidence-based predictive nursing on patients with relapsed/refractory B-cell lymphoma undergoing chimeric antigen receptor (CAR) T-cell therapy. Methods Eighty patients with relapsed/refractory B-cell lymphoma who underwent CAR T-cell therapy at Ruijin Hospital between January 2022 and May 2023 were enrolled in the study. Using the envelope method, the patients were randomly assigned to either a control group (n=40), receiving standard nursing care, or an intervention group (n=40), receiving predictive nursing based on evidence-based practice. The intervention included structured problem identification, targeted evidence collection, and implementation of proactive nursing strategies. Clinical outcomes which were compared between the two groups included psychological status, fatigue severity, and treatment-related complications. Results Before nursing intervention, there were no significant differences in anxiety or depression scores between the two groups. After intervention, the intervention group showed significantly lower anxiety and depression scores (P<0.05). Fatigue levels and related dimensions (behavioral, emotional, cognitive, and sensory) also improved significantly in the intervention group compared with the control group (P<0.05). The incidence of cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS) was lower in the intervention group (65.00% and 15.00%, respectively) than that in the control group (82.50% and 27.50%). There was no significant difference in the overall rate of adverse events between the two groups. There was one case of grade 3-4 CRS and none grade 3-4 ICANS in the intervention group, while there were three cases of grade 3-4 CRS and one case of grade 3-4 ICANS in the control group. Conclusions Evidence-based predictive nursing demonstrates clear clinical value in the management of patients undergoing CAR T-cell therapy with relapsed/refractory B-cell lymphoma. It effectively alleviates psychological distress, reduces fatigue, lowers the risk of severe toxicities, and enhances overall safety and quality of care. These findings support its broader implementation in clinical practice.

Key words: Evidence-based nursing, Predictive nursing, Chimeric antigen receptor T-cell therapy, Relapsed/refractory B-cell lymphoma, Application effect

CLC Number:

R733.4

ZHENG Xin, CHEN Lian. Application in evidence-based predictive nursing on patients with relapsed/refractory B-cell lymphoma receiving chimeric antigen receptor T-cell immunotherapy[J]. Journal of Internal Medicine Concepts & Practice, 2025, 20(03): 248-253.

Figures/Tables 3

Table 1

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Table 3

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量表	阶段	对照组	观察组	t	P
HAMD	护理前	11.55±3.21	11.62±3.15	0.098 4	0.921 8
HAMD	护理后	6.78±1.57	4.89±1.21	6.030 4	<0.00 1
HAMA	护理前	14.69±2.09	14.76±2.03	0.151 9	0.879 6
HAMA	护理后	7.98±1.67	5.78±1.28	6.612 7	<0.00 1

评估内容	对照组	观察组	t	P
疲乏行为及程度
护理前	25.21±4.75	25.24±4.71	0.028 3	0.977 4
护理后	21.09±3.98	15.68±3.22	6.683 4	<0.001
情感
护理前	26.24±5.12	26.29±5.09	0.043 8	0.965 2
护理后	22.78±4.32	15.24±3.58	8.499 4	<0.001
认知与情绪
护理前	20.56±4.67	20.68±4.56	0.116 2	0.907 7
护理后	17.31±4.09	12.98±3.45	5.118	<0.001
感觉
护理前	24.25±5.17	24.26±5.11	0.008 7	0.993 1
护理后	20.11±4.21	17.38±4.07	2.948 5	0.004 2

并发症	观察组	对照组	χ²	P
CRS
1-2级	25/62.50	30/75.00
3-4级	1/2.50	3/7.50
任何级别发生率	26/65.00	33/82.50	3.164	0.075
ICANS
1-2级	6/15.00	10/25.00
3-4级	0/0	1/2.50
任何级别发生率	6/15.00	11/27.50	1.867	0.172